Case of the Month

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.
Pertinent Labs
  • 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
Physical Exam
  • 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?
  1. Upper lobe predominant opacities
  2. Expanded ribs
  3. H-shaped vertebrae
  4. Cardiomegaly
  5. Normal radiograph
  6. Interstitial opacities
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