Mystery Quiz

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 …

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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 of the infiltrates.…

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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 but was otherwise …

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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 can result from a variety of aspirated …

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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 preoperative evaluation …

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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 or significant history of smoking. There was …

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How Frequently Should You Perform a Follow-Up Colonoscopy-A multiple choice quiz

January 2, 2007
How Frequently Should You Perform a Follow-Up Colonoscopy-A multiple choice quiz

Commentary By Michael Poles, M.D. Gastroenterologist, Assistant Professor of Medicine, Mircrobiology and Pathology.

Every once in a while I will be feeding this new blorganism (or is it bloganism?) with content from the world of gastroenterology. Today I would like to review an article of importance to both gastroenterologists and internists. There is likely no topic in gastroenterology more important than that of colorectal cancer screening. Colorectal cancer is the second most common cause of cancer death in the U.S., and it takes up an enormous …

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Mystery Quiz #1-The Answer…

December 20, 2006
Mystery Quiz #1-The Answer…

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 fissure, ordinarily not visible, but now …

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Mystery Quiz-Radiology

December 13, 2006
Mystery Quiz-Radiology

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.  For those of you who are …

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