Vivian Hayashi MD, Robert Smith MD
The patient is an 82 year old man with frequent breathlessness. The patient had been admitted several times in the past two years for congestive heart failure. Two years earlier, the patient suffered an NSTEMI. A diagnostic cardiac catheterization revealed triple vessel coronary disease. A …
Vivian Hayashi MD, Robert Smith MD
The answer to the mystery quiz is rhabdomyolysis due to legionella pneumonia (LP). The presentation of the patient, namely severe rhabdomyolysis complicated by acute kidney injury, obscured the presence of a subtle retrocardiac density that is visible on the CXR (Image 2, asterisk). …
Vivian Hayashi MD, Robert Smith MD
A 51 year old man presented to the emergency room with fever and myalgias for four days. The patient was previously in good health except for occasional asthmatic exacerbations. He noted thigh pain in the few days prior to admission, for which he took …
Vivian Hayashi MD, Robert Smith MD
The answer to the Mystery Quiz is diaphragmatic hernia, specifically a Bochdalek hernia. The CXR shows increased density behind the heart that has a smooth superior border (Image 2, arrows). This density does not obscure the left heart border, denoting a posterior location behind …
Vivian Hayashi MD, Robert Smith MD
The patient is a 78 year old man who presented to the emergency room with fever, pain, swelling, and erythema of the right leg over a two day period. The patient denied abdominal symptoms, cough or breathlessness over his baseline. His past medical history included …
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 …
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 …
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 …