Before you read the answer you should read the orginal post form last week

The Final Poll Results (26 votes): metastatic disease (26%) , mycobacterial disease (22%) ,fungal disease (22%), bronchiolitis obliterans with organizing pneumonia (boop) (13%), septic emboli (9%) ,vasculitis, e.g. wegener’s (4%), thromboembolic disease (4%), sarcoid (0%)

The patient had granulomatous inflammation on pathology with acid-fast organisms seen. The culture grew mycobacterium avium (MAC). After treatment with azithromycin, ethambutol and rifabutin for eighteen months, the follow-up imaging showed significant clearing…

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Posted By Robert Smith, MD Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine

The patient is an 81 year old male with severe obstructive lung disease who was referred to the pulmonary service for an abnormal chest x-ray prior to femoral-popliteal bypass surgery.   The patient complained of chronic dyspnea on exertion but specifically denied hemoptysis, increased cough, fever or night sweats.   Initial cxr revealed the following:

A chest ct showed only a spiculated appearing mass in the left upper lobe…

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Before you read the answer you will probably want to review the original post of the mystery quiz from last week.

The pathology has been correctly identified.  The photomicrograph shows lipoid pneumonia, which in fact was due to chronic mineral oil ingestion (aspiration). The patient suffered from constipation, due to long usage of oxycondone, and medicated himself with mineral oil. The pathology shows lipid material, some of it pooled into large coalescent droplets, some in macrophages.

Lipoid pneumonia…

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Since we received little in the way of responses to our mystery quiz, we thought a hint might be in order, so here's the case again this time with a hint.  Please submit your answers by clicking on the "comments" link below this post.  As always, for those of you who are unwilling to attach your name,  you can post your comments anonymously. 

The patient is a 77 year old male whose chief complaint was severe left hip pain of five years duration.  As part of a…

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Posted By Robert Smith, MD Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine

The patient is a 77 year old male whose chief complaint was severe left hip pain of five years duration.  As part of a preoperative evaluation for hip surgery, a routine chest x-ray was obtained as below.  Click on the thumbnails below for full size images:

A prior film done six months previously showed similar but less impressive findings. Upon review, the patient denied any pulmonary symptoms…

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Before you read the answer you will probably want to review the original post of the mystery quiz from last week.

The Answer:

The chest film shows a probable mass in the area of the left hilum and associated complete collapse of the left upper lobe.  The key findings are loss of volume of the left hemithorax indicated by elevation of the left hemidiaphragm and shift of the mediastinum to the left side.  Additionally, the arrows indicate the major…

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Posted By Robert Smith, MD Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine 

62 year old male smoker with past medical history notable for hypertension, copd, comes to clinic complaining of chronic cough x 6 months with minimal sputum, no wheezing.  Lung exam shows decreased breath sounds throughout.  Pt had the following CXR performed:

Click on Thumbnail to Enlarge

What's your diagnosis and the next step in his evaluation?  Please submit your answers by clicking on the "comments" link below this post. …

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