Pulmonary
The Southwest Journal of Pulmonary and Critical Care publishes articles broadly related to pulmonary medicine including thoracic surgery, transplantation, airways disease, pediatric pulmonology, anesthesiolgy, pharmacology, nursing and more. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.
June 2020 Pulmonary Case of the Month: Twist and Shout
Lewis J. Wesselius, MD1
Staci E. Beamer, MD2
1Departments of Pulmonary Medicine and 2Thoracic Surgery
Mayo Clinic Arizona
Scottsdale, AZ USA
History of Present Illness
An 83-year-old man presented with a left upper lobe lung nodule. The nodule was noted on a routine follow-up chest radiograph obtained after a radical cystectomy and left nephro-ureterectomy done 9 months earlier for invasive bladder cancer as well clear cell carcinoma of left kidney. He had symptoms of a mild chronic cough but denied shortness of breath with activities of daily living.
PMH, SH, FH
-
Prostate cancer, post prostatectomy in 2009.
-
Bladder cancer and left renal cell cancer resected in Jan 2019
-
Post-op chemotherapy after bladder and left kidney resections
-
Non-ischemic cardiomyopathy, possibly due to chemotherapy, EF 45%
-
Chronic atrial fibrillation
-
Smoking history: 60 pack years, no occupational exposures
Physical Examination
Other than an irregular pulse, his physical examination was unremarkable.
Medications
-
Warfarin
-
Atorvastatin
-
Hydrochlorothiazide
-
Ramipril
-
Atenolol
Radiography
The initial chest radiograph is shown in Figure 1.
Figure 1. Initial chest x-ray.
Which of the following should be done at this time? (Click on the correct answer to be directed to the second of eight pages)
Cite as: Wesselius LJ, Beamer SE. June 2020 pulmonary case of the month: twist and shout. Southwest J Pulm Crit Care. 2020;20(6):179-87. doi: https://doi.org/10.13175/swjpcc038-20 PDF