Sponsored Advertisement

Thursday, November 15, 2007

Routine Screening Radiograph in a 60-Year-Old Smoker

Here's a way to check your diagnostic skills..


A 60-year-old man presents to the emergency department (ED) for pain in the right side of his chest after accidentally tripping over a sidewalk curb and falling. The patient states that when he fell he hit the right side of his chest on the sidewalk. On the review of systems, the patient does not report any shortness of breath or difficulty breathing, but he does report occasionally having a dry cough. He states that he has had the cough “for quite some time,” and he attributes it to his 40-pack-year history of smoking cigarettes. On further questioning, he denies having any weight loss, hemoptysis, or shortness of breath.

On physical examination, the patient’s vital signs are noted to be normal and stable; his heart rate is 85 bpm, his blood pressure is 120/85 mm Hg, and he has an oxygen saturation of 99% while breathing room air. The patient is a man of moderate build in no apparent distress. He has normal breath sounds. The findings of the chest and abdominal examinations are unremarkable except for mild tenderness to palpation over the right chest wall; the general physical examination is otherwise unremarkable.

Chest radiographs are obtained to evaluate for possible injuries to the patient’s ribs and lungs. As a result of the radiographic findings (see Images 1-2), a complete blood count (CBC) and chemistry panel are ordered, but the results are unremarkable. The abnormality noted on the plain radiographs, combined with poor follow-up for the patient, prompts a contrast-enhanced computed tomography (CT) scan of the chest (Image 3).


The diagnosis is the most common benign tumor of the lung.


See Answer

No comments: