Mystery Quiz

Mystery Quiz

July 23, 2008
Mystery Quiz

Posted by Nishay Chitkara MD, Instructor of Clinical Medicine, Division of Pulmonary and Critical Care Medicine, Vivian Hayashi MD, Instructor of Clinical Medicine, Division of General Internal Medicine and Robert Smith MD, Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine 

A 49 year old undomiciled male with a history of hepatitis C, mycobacterium avium complex colonization of the lungs, and active alcohol abuse presented with fevers, cough productive of green sputum, and an elevated white blood cell count. His symptoms were persistent despite broad…

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Mystery Quiz- The Answer

June 26, 2008
Mystery Quiz- The Answer

Posted by Athena Kritharis MS-3, Vivian Hayashi MD, Instructor of Clinical Medicine, Division of General Internal Medicine and Robert Smith MD, Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine

 

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The answer to last week’s mystery quiz is giant hemangioma. The CT is highly suggestive of the diagnosis given the peripheral enhancement with hypodense center (Image 1). Had the study been done dynamically, the contrast would have moved centrally. Contrast…

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Mystery Quiz

June 19, 2008
Mystery Quiz

Posted by Athena Kritharis MS-3, Vivian Hayashi MD, Instructor of Clinical Medicine, Division of General Internal Medicine and Robert Smith MD, Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine

The patient is a 42 year old Caucasian woman with no significant past medical history who presents with diffuse abdominal pain for two months that progressed to acute epigastric pain followed by nausea and vomiting. The vomitus was “milky” and contained only food particles. Symptoms were not relieved with over-the-counter antacids. The patient recalls eating scallops…

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Mystery Quiz- The Answer

February 6, 2008
Mystery Quiz- The Answer

Posted By: Vivian Hayashi, MD, Instructor of Clinical Medicine, Division of General Internal Medicine and Robert Smith, MD Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine

The answer to the mystery quiz is lung cancer, in particular, adenocarcinoma with a predominantly bronchoalveolar cell pattern (BAC).  The clue to the mystery was the “cough productive of voluminous frothy, watery sputum,” bronchorrhea, which is often the presenting complaint of patients with BAC. Other entries in the differential diagnosis are characterized by cough that is non-productive such as…

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Mystery Quiz

January 29, 2008
Mystery Quiz

Posted By: Vivian Hayashi, MD, Instructor of Clinical Medicine, Division of General Internal Medicine and Robert Smith, MD Associate Professor of Medicine, Division Pulmonary and Critical Care Medicine

A 78 year old man with a history of ankylosing spondylitis and known cardiac disease associated with congestive heart failure, presented with breathlessness one year prior to admission.  Over the most recent months, the patient complained of cough productive of voluminous frothy, watery sputum.  Medications included digoxin, furosemide, irbesartan, isosorbide, metoprolol, spirinolactone, simvastatin, and warfarin.  The patient had worked…

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X Ray Visions Mystery Quiz- The Answer

August 30, 2007
X Ray Visions Mystery Quiz- The Answer

Before you read the answer, you may want to review the initial Mystery Quiz posted last week.

Commentary by Andrew Hardie MD, Fellow, NYU Department of Radiology

Although this patient’s symptoms were not the most typical of this entity, the CT findings in this case are diagnostic of a perforated anterior duodenal ulcer. The most essential observation, and the one that alters management, is the presence of intraabdominal free air (arrows). The small collections of air in this case are not unusual for bowel perforations,…

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X-Ray Visions: Mystery Quiz

August 22, 2007
X-Ray Visions: Mystery Quiz

A 46 year old male with a past medical history of hypertension presents to the emergency room complaining of constant throbbing epigastric pain for one day. He rates the pain as 7/10, with some radiation to his chest. He reports some mild nausea, but denies diarrhea or constipation.  He does endorse a bloated sensation for the past few days. He has not had any fevers and denies melana or hematochezia.  He is an avid biker and reports unlimited exercise tolerance. He denies any previous history of chest pain.

The patient works as…

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Mystery Quiz #3-The Answer

May 15, 2007
Mystery Quiz #3-The Answer

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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Mystery Quiz

May 3, 2007
Mystery Quiz

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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Mystery Quiz #2-The Answer

February 6, 2007
Mystery Quiz #2-The Answer

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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Mystery Quiz #2 (with a hint…)

January 30, 2007
Mystery Quiz #2 (with a hint…)

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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Mystery Quiz #2

January 22, 2007
Mystery Quiz #2

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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