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January 2014

Preoperative Chest X-rays: A Teachable Moment

Author Affiliations
  • 1University of Colorado School of Medicine, Aurora
  • 2Department of Ambulatory Care, Denver VA Medical Center, Denver, Colorado
JAMA Intern Med. 2014;174(1):12. doi:10.1001/jamainternmed.2013.10531

Mr X, a man in his mid 50s with a history of mild intermittent asthma and an increasingly painful umbilical hernia, presented to a general surgery clinic for a preoperative evaluation. Basic laboratory test results and cardiopulmonary examination findings were normal, and a reducible hernia was noted. A chest radiograph (CXR) was obtained for the indication of preoperative evaluation in a patient with asthma older than 55 years. The CXR revealed a 7-mm left perihilar lung nodule, with a radiologist recommending further evaluation of the lung with computed tomography (CT). As a result, hernia surgery was delayed and CT scan of the chest was undertaken.

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