Radiology

Mammograms in the News, Yet Again

February 13, 2014
Mammograms in the News, Yet Again

By Miguel A. Saldivar, MD

Peer Reviewed

Mammograms are far from strangers to the paparazzi. It was only recently that a television news reporter from a prominent broadcasting company reluctantly agreed to have a mammogram performed on live television to promote breast cancer screening and help “save lives” . That same study diagnosed her with breast cancer, which was followed by the impressive statement from her physicians: “that mammogram just saved your life”. But over the last day or two several major newspapers are presenting…

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Is there a Non-Invasive Method to Diagnose Cirrhosis/Hepatic Fibrosis?

October 11, 2013
Is there a Non-Invasive Method to Diagnose Cirrhosis/Hepatic Fibrosis?

By Becky Naoulou, MD

Faculty Peer Reviewed

Clinical Question:

You are asked to see a 45 year-old male with a medical history significant for untreated hepatitis C (HCV RNA 5,000,000 copies/mL, genotype 1a). He presents complaining of worsening fatigue and weakness for several months. Labs are remarkable for mildly elevated transaminases, low albumin, and an elevated INR. The patient is very worried because he has heard that hepatitis C can cause liver cancer and asks you if there is a non-invasive screening test for liver…

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Mystery Quiz-The Answer

January 10, 2013
Mystery Quiz-The Answer

Elizabeth Mulaikal MD, Vivian Hayashi MD, Robert Smith MD

The answer to the mystery quiz is pulmonary Mycobacterium kansasii infection. The patient’s clinical presentation of fevers and night sweats suggested an infectious process or B symptoms due to lymphoma. The initial chest radiograph (image 1) demonstrated a left hilar mass which was noted to be larger on a subsequent chest radiograph (images 2 and 4)) 1 month later. This increase in size over a short duration again suggested an infectious etiology. Importantly and a key…

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Mystery Quiz

December 21, 2012
Mystery Quiz

Elizabeth Mulaikal MD, Vivian Hayashi MD, Robert Smith MD

The patient is a 55 year old African American male with a 60 pack year history of tobacco use and AIDS,who presented with 1 month of intermittent fevers and weight loss. His most recent CD4 count and viral load were 2/cmm and 50,623 copies/mL, respectively. Prior opportunistic infections included pneumocystis pneumonia and thrush. He was previously homeless, but currently resides in a Single Room Occupancy Housing. Upon presentation he complained of occasional night sweats, but no…

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Mystery Quiz- The Answer

June 29, 2012

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The answer to the mystery quiz is thymoma associated with myasthenia gravis. The clue to the case is the intermittent dysphagia and chewing difficulty. If one considers myasthenia in the differential, then an otherwise grossly normal appearing chest radiograph may be viewed more closely, with attention directed to the upper, anterior mediastinum. The chest radiograph shows the ascending aorta (image 3, arrow); on the lateral film, the retrosternal space, which normally contains air, appears…

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Mystery Quiz

June 19, 2012
Mystery Quiz

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is a 61 year old man admitted to the psychiatry service for depression. During the hospitalization the patient reported a three year history of dysphagia and occasional right sided chest pain not clearly associated with exertion. He first noted difficulty chewing and swallowing turkey on Thanksgiving Day. The symptoms were intermittent thereafter and involved solid foods but not liquids. His chewing and swallowing difficulty abated for a year but returned one year…

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What are the Barriers to Using Low Dose CT to Screen for Lung Cancer?

February 23, 2012
What are the Barriers to Using Low Dose CT to Screen for Lung Cancer?

By Benjamin Lok

Faculty Peer Reviewed

Lung cancer is the most common cause of cancer deaths globally and responsible for an estimated 221,120 new cases and 156,940 deaths in 2011 in the United States. Presently, the United States Preventive Services Task Force, the National Cancer Institute (NCI), the American College of Chest Physicians, and most other evidence-based organizations do not recommend screening for lung cancer with chest x-ray or low-dose helical computed tomography (CT) due to inadequate evidence to support mortality reduction. This…

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Mystery Quiz- The Answer

December 14, 2011
Mystery Quiz- The Answer

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors
The answer to the mystery quiz is Kaposi’s sarcoma. The CXR shows bilateral confluent airspaceopacities which have a wide differential diagnosis in this case. The CT narrows the differential.  Specifically, the opacities appear to emanate from the central hilar areas, cuff the airways, and fan out into the more distal airspaces (Images 3 and 4).  This appearance is very suggestive of Kaposi’s sarcoma. CT scans may also reveal mediastinal lymphadenopathy and large

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Mystery Quiz

December 9, 2011
Mystery Quiz

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is a 52 year old African-American man who presented with breathlessness and weight loss over one month along with watery stools during the week prior to admission. He had a history of untreated HIV infection, a CD4 cell count of 5/cmm, oral candidiasis, and peri-rectal HSV infection. The patient reported occasional cough with variable sputum production but denied fever, night sweats, hemoptysis, recent travel, or sick contacts. His risk factor for HIV…

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Mystery Quiz

November 30, 2011
Mystery Quiz

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is a 52 year old African-American man who presented with breathlessness and weight loss over one month along with watery stools during the week prior to admission. He had a history of untreated HIV infection, a CD4 cell count of 5/cmm, oral candidiasis, and peri-rectal HSV infection. The patient reported occasional cough with variable sputum production but denied fever, night sweats, hemoptysis, recent travel, or sick contacts. His risk factor for HIV…

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Mystery Quiz- The Answer

June 17, 2011
Mystery Quiz- The Answer

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The answer to the mystery quiz is lymphangitic carcinomatosis (LC). The diffuse interstitial and infiltrative pattern seen on CXR is best appreciated on the CT of the chest. On Images 4, 5 and 6, interlobular septal thickening is apparent (arrow) and is due to tumor infiltration of interstitial lymphatics. Also evident on these images (arrowhead) is diffuse peribronchial thickening due to tumor infiltration of the airways. Image 6 (open arrowhead) additionally shows pleural nodules,…

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Mystery Quiz

June 16, 2011
Mystery Quiz

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is a 62 year old man presenting with increasing breathlessness for the past six weeks. The patient first noted symptoms of mild shortness of breath and cough productive of yellow sputum that he attributed to his yearly winter cold. The sputum cleared and at presentation the patient had largely unproductive cough. A construction worker until six months earlier, the patient’s unlimited exercise tolerance was now limited to minimal exertion. He denied current…

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