Image of the Month—Quiz Case | Pulmonary Medicine | JAMA Surgery | JAMA Network
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Special Feature
September 1, 2004

Image of the Month—Quiz Case

Author Affiliations

Grace S.RozyckiMDFrom the Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY.

Arch Surg. 2004;139(9):1017-1018. doi:10.1001/archsurg.139.9.1017

An 18-year-old man with a history of asthma presented at a rural hospital with shortness of breath and left shoulder pain. A chest radiograph was obtained, which demonstrated a left pneumothorax; it was decompressed by means of a Foley catheter. The patient had had a similar episode with a similar chest radiograph 3 weeks previously. His medical history was significant for asthma, for which he used multiple inhalers. Results of physical examination showed a cachectic man, 1.6 m tall who weighed 42.3 kg. His vital signs were stable, with a blood pressure of 110/80 mm Hg, apulse of 80 beats/min, and a respiratory rate of 20/min. His lungs were clear to auscultation, and the cardiac examination showed a 2/6 systolic ejection murmur. The patient was transferred to our facility for further management of a recurrent pneumothorax. On arrival at our facility, a chest radiograph was obtained (Figure).

What Is the Diagnosis?

A.Small left apical pneumothorax, left tube thoracostomy, and bilateral hilar adenopathy

B.Small left apical pneumothorax and left tube thoracostomy

C.Small left apical pneumothorax, left tube thoracostomy, and a right hilar mass

D.Small left apical pneumothorax, left tube thoracostomy, and a prominent right central pulmonary artery