Specific Discussion

The presence of a subacute illness with foul-smelling sputum and clubbing is a classical presentation for a lung abscess, which is caused by mixed aerobic and anaerobic infection. Pneumococcal pneumonia generally does not produce a necrotizing picture, and PCP in an immune-compromised patient usually appears as a diffuse reticular pattern, but cystic and cavitary areas may be present. A lung abscess represents a localized area of lung necrosis with a thick...

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A 50-year-old male smoker is evaluated for chronic shortness of breath. On physical examination his vital signs are pulse 110 bpm temperature normal respirations 30 min with use of accessory muscles and pursed-lip breathing blood pressure 110 78 mm Hg. Other pertinent findings are heart exam apex beat (impulse) is medial to the midclavicular line with generalized decreased breath sounds on lung exam ABGs (FiO2 0.21) pH 7.38 Pco2 47 mm Hg Po2 67 mm Hg. PFTs spirometry FVC 2.80 L (67 of...

Lung Masses

Description of X-rays in This Chapter Figure 9. A large, 7 x 11-cm mass is seen in the left parahilar area. This has a well-defined edge and silhouettes out the hilar structures. The diaphragms are flattened, and there is no pleural disease. There are mediastinal (sternal) wires from prior CABG. Figure 10. This chest x-ray shows a 3 x 2.5-cm rounded masslike shadow in the right middle zone with slightly irregular margins. There is an area of nonspecific infiltrate above this mass with air...

Solitary Pulmonary Nodule

DIRECTIONS Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question. 1. A 40-year-old male smoker presents with a history of chronic cough. He has had symptoms of an upper respiratory illness for a few months since visiting family in Arizona. Physical exam is normal. CXR is shown below in Fig. 1. The next step in management should be a. Complete pulmonary function tests d. Observation and repeat CXR in 6 to 8 mo A...

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A 44-year-old man with a history of chronic bronchitis is admitted with severe shortness of breath and left-sided chest pain. CXR is shown in Fig. 48. EKG shows left ventricular strain. 84. What is the most likely diagnosis to explain the symptoms 85. Physical findings will likely entail a. Decreased breath sounds on the left side with stony dullness on percussion b. Absent breath sounds with hyperresonance on the left side c. Decreased breath sounds with rhonchi bilaterally d. Bilateral...

Description of Xrays in This Chapter

This PA chest film demonstrates a large superior mediastinal shadow with marked right displacement of the trachea. There is minimum thickening of the minor fissure with some small atelectatic streaks on the left. The descending aorta is tortuous and shows a small amount of calcification in the aortic knob. Although this film is most consistent with a thyroid goiter, a CT scan would be definitive. Figure 57. This lateral chest radiograph shows an anterior mediastinal mass in the lower...