Our Imaging Case of the Month is presented as a part of the Imaging Department's residency teaching program. Each month a resident collaborates with one of our attending imaging physicians to present an interesting case to the Cedars-Sinai medical community. The case is used to teach both imaging and other residents at Cedars-Sinai. Below is the current Case of the Month.
Submitted by Catherine Evans, MD, and Thomas J. Learch, MD
History of Present Illness:
32-year-old female with history of sickle cell disease, autoimmune hemolytic anemia, previous DVTs and PE, and sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman syndrome) who presented to the emergency room with complaints of severe stabbing chest pain occurring over the past day.
Review of Systems
- Constitution: Negative for chills, fever, weakness and malaise/fatigue.
- HENT: Positive for congestion. Negative for ear discharge, ear pain and headaches.
- Cardiovascular: Positive for chest pain. Negative for dyspnea on exertion, irregular heartbeat, leg swelling, near-syncope and palpitations.
- Respiratory: Positive for cough. Negative for hemoptysis, shortness of breath, snoring, sputum production, stridor and wheezing.
- Neurological: Negative for headaches.
- All other systems reviewed and are negative.
- Significant lab, reference values
- Troponin I - <0.01
- WBC 5.3
- Glucose 109 (*) 70 - 99 MG/DL
- RBC 2.58 (*) 3.67 - 5.11 MILL/UL
- Hemoglobin 8.6 (*) 11.6 - 15.4 g/dL
- Hematocrit 24.9 (*) 34.3 - 45.4 %
- MCH 33.3 (*) 27.0 - 33.0 pg
- RDW 16.3 (*) 11.7 - 14.4 %
- Reticulocyte count 6.1 (*) 0.5 - 2.0 %
- Reticulocyte Count Absolute 160000 (*) 10000 - 100000 /UL
- IRF Index 34.5 (*) 1.1 - 15.9 %
- ReticHgb Equiv 35.9 (*) 29.0 - 35.0 pg
- Vitals: Blood pressure 130/70, pulse 90, respirations 20/min, temperature 97.8
- GENERAL: Obese female in no acute distress
- HEENT: NCAT
- CHEST: Rhonchi at the bases
- CARDIAC: RRR
- Abdomen: Soft, nontender to palpation
- EXTREMITIES: Postsurgical change right shin post woundVAC
Which of the following is not a typical finding of sickle cell disease on a chest x-ray?
- Upper lobe predominant opacities
- Expanded ribs
- H-shaped vertebrae
- Normal radiograph
- Interstitial opacities
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