Category: Mystery Quiz

Clinical Correlations


Mystery Quiz

Vivian Hayashi MD, Robert Smith MD

The patient is a 72 year old man who presented with an incidentally noted right mid-lung density on a chest radiograph.  The patient was asymptomatic at the time and was begun on empiric treatment with moxifloxacin, then a course of amoxicillin-clavulanate for a presumed pneumonia (Image 1), without substantive improvement. …

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Mystery Quiz-The Answer

Before you read the answer, please review the original Mystery Quiz posted 11/18/16.

Vivian Hayashi MD, Robert Smith MD

The answer to the mystery quiz is aspiration pneumonia.  The CXR (Image 1) shows a total opacification of the right hemithorax.  Importantly, the tracheal air column is deviated to the side of the opacification. …

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Mystery Quiz

Vivian Hayashi MD, Robert Smith MD

The patient is an 86 year old man who presented with weakness, lethargy and falls.  His history was noteworthy for an episode of empyema nine years earlier that was managed with tube thoracostomy followed by decortication. …

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Mystery Quiz

Vivian Hayashi MD, Robert Smith MD

The patient is an 86 year old man who presented with weakness, lethargy and falls.  His history was noteworthy for an episode of empyema nine years earlier that was managed with tube thoracostomy followed by decortication. …

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Mystery Quiz-The Answer

Vivian Hayashi MD, Robert Smith MD

The answer to the mystery quiz is methicillin-resistant S. aureus (MRSA) pneumonia. The initial CXR (image 4) showed increased density in the area of the left hilum, hinting at a process in the superior segment of the left lower lobe.…

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Mystery Quiz

Vivian Hayashi MD, Robert Smith MD

The patient is a 46 year old female who presented to the emergency room with breathlessness, productive cough, subjective fever, and myalgia for one week. Her history was notable for mild persistent asthma treated with tiotropium, mometasone, formoterol, and albuterol as needed.…

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Mystery Quiz-The Answer

Vivian Hayashi MD, Robert Smith MD

The answer to the mystery quiz is pleural effusions, specifically, bilateral subpulmonic effusions. The chest radiograph shows a number of findings: (1) the apparent diaphragm shadow is in fact fluid sandwiched between the undersurface of the lung and the actual diaphragm (Image 2a, arrow); (2) the density of this shadow is homogenously white (Image 2a, asterisk) and differs from a normal diaphragm which has a graded density (Image 2b, triangle) due to superimposed air that progressively decreases towards the bases (Image 3b); (3) the actual diaphragm (Image 2b, double arrows) begins its descent more medially than the descent of the subpulmonic effusion (Image 2a); and (4) the distance between the top of the gas bubble and the left hemidiaphragm is very small in the normal radiograph (Image 2b), compared with the increased distance due to the subpulmonic effusion (Image 2a).…

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