November 2017 Imaging Case of the Month

Michael B. Gotway, MD¹

Isabel Mira-Avendano, MD²

¹Mayo Clinic Arizona, Scottsdale AZ USA

²Mayo Clinic Jacksonville, FL USA

Clinical History: A 70-year-old white woman with a remote history of smoking and mild gastroesophageal reflux disease presented with complaints of a dry cough and shortness of breath, present for some time but worsening over the previous 8 months. No hemoptysis was noted and the patient did not complain of chest pain. No history of syncope was noted.

Physical examination was largely unremarkable and the patient’s oxygen saturation was 86% on room air, 90% on 4 L/m by mask. The patient’s vital signs were within normal limits.

Laboratory evaluation was unremarkable.  Quantiferon testing for Mycobacterium tuberculosis was negative, and testing for coccidioidomycosis was unrevealing. Enhanced thoracic CT (Figure 1) was performed.

Figure 1. Panels A-D: Representative static images from the thoracic CT scan in lung windows. Lower panel: Video of thoracic CT scan in lung windows.

Which of the following statements regarding the thoracic CT is most accurate? (Click on the correct answer to proceed to the second of eight pages)

1. The thoracic CT shows advanced destructive emphysema
2. The thoracic CT shows bilateral, basal and subpleural predominant reticulation associated with ground-glass opacity, architectural distortion, and traction bronchiectasis
3. The thoracic CT shows multifocal lobular consolidation
4. The thoracic CT shows multifocal small pulmonary cysts
5. The thoracic CT shows small cavitary pulmonary nodules

Cite as: Gotway MB, Mira-Avendano I. November 2017 imaging case of the month. Southwest J Pulm Crit Care. 2017;15(5):199-208. doi: https://doi.org/10.13175/swjpcc134-17 PDF