Imaging

Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology.

The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend. Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology. The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend.

Rick Robbins, M.D. 11/1/20 Rick Robbins, M.D. 11/1/20

November 2020 Imaging Case of the Month: Cause and Effect?

Prasad M. Panse MD

Clinton E. Jokerst MD

Michael B. Gotway MD

Department of Radiology

Mayo Clinic, Arizona

Phoenix, Arizona USA

Clinical History: A 36 -year-old woman with Crohn’s disease and ulcerative colitis diagnosed approximately 1 year earlier, was initially treated with adalimumab, but later switched to prednisone and budesonide when subcutaneous nodules and migraines were attributed to this medication. Subsequently a flare of gastrointestinal symptoms prompted hospitalization with colonoscopy which showed severe pancolitis consistent with ulcerative colitis. One month following hospital discharge, the patient then presented to the Emergency Department with continued complaints of nausea, diarrhea, abdominal pain, intermittent fever (self-measured to 101º F), joint pain, and a pruritic rash all over her body. These symptoms had occurred following her hospitalization 2 months earlier. She also complained of 25 lbs. weight loss over the previous year.

In addition to prednisone and budesonide, the patient’s medications included hydroxyzine, famotidine, vitamin C, and hydrocodone-acetaminophen. The patient denies allergies and did not smoke nor use drugs.

Physical examination showed the patient to be afebrile with normal heart and respiratory rates and blood pressure = 112/75 mmHg. Her room air oxygen saturation was 99%. Her examination was remarkable for tenderness to palpation over the left > right lower quadrants with rebound tenderness and positive fecal occult blood testing. Her skin examination also showed a diffuse, pinpoint, maculopapular rash affecting her trunk as well as both the upper and lower extremities.

The patient’s complete blood count and serum chemistries showed hypokalemia=3.0 mmol/L (normal, 3.6-5.2 mmol/L), mild anemia (hemoglobin / hematocrit = 11.2 gm/dL / 34.3% [normal, 12.3-15.7 gm/dL / 37-46%]), and a minimally elevated lipase of 63 U/L (normal, 13-60 U/L). Liver and renal function testing were within normal limits.

Which of the following represents an appropriate next step for the patient’s management?

Cite as: Panse PM, Jokerst CE, Gotway MB. November 2020 Imaging Case of the Month: Cause and Effect? Southwest J Pulm Crit Care. 2020;21(5):108-120. doi: https://doi.org/10.13175/swjpcc058-20 PDF