Phillip M. Boiselle, MD


What caused this woman’s pneumomediastinum?

July 29, 2008

A 35-year-old woman presented to the emergency department (ED) with vague abdominal complaints. The patient had a complex medical history that included diverticulosis and relapsing polychondritis. Initially, her polychondritis was limited to involvement of the ears and nose. Within the past few years, however, her polychondritis flares had been associated with progressive dyspnea, which prompted intermittent and then long-term use of high-dose oral corticosteroids.

A 58-year-old man with facial flushing and dyspnea

June 01, 2008

A previously healthy 58-year-old man presented to the emergency department with a 4-week history of gradually progressive dyspnea, facial flushing, and night sweats. Three weeks before presentation, he received the diagnosis of acne rosacea from an outside physician and was given topical treatments, with no relief in symptoms. One week before presentation, he began to notice swelling of the face, neck, and right arm and dysphagia (initially with solids, then progressing to liquids).

What caused an elevated diaphragm in this woman with cough and dyspnea?

September 01, 2007

A 52-year-old woman presented to her primary care physician complaining of a nonproductive cough and dyspnea on exertion. These symptoms had a subacute onset over 4 weeks before her initial visit. She denied fever, sputum production, hemoptysis, chest pain, palpitations, abdominal pain, nausea, vomiting, and diarrhea. She did not have any known sick contacts.

What caused recurrent pneumonia and hemoptysis in this woman?

July 01, 2007

A 53-year-old woman presented to the emergency department complaining of substernal chest pain that awoke her from sleep. The chest pain was associated with left shoulder numbness, radiating to her back, and was partially alleviated with sublingual nitroglycerin. During this episode, the patient had a cough productive of yellow phlegm and one instance of cough productive of 1 tbs of bright red blood.

What caused arm numbness and epistaxis in this man?

May 01, 2007

A 38-year-old man presented to the emergency department after experiencing the sudden onset of right upper extremity numbness, heaviness, and loss of coordination, which resolved after 20 minutes. He had 2 similar episodes 19 years and 11 years earlier. Diagnostic evaluation (including MRI of the brain, carotid Doppler ultrasonography, and echocardiography) at the time of the second episode was unrevealing.

What caused these findings in a patient with atrial fibrillation?

February 01, 2007

A 69-year-old man with a history of atrial fibrillation, pulmonary embolism, asthma, and obstructive sleep apnea presented to the emergency department for evaluation of dyspnea and light-headedness. He had been treated for paroxysmal atrial fibrillation over the past 5 years; fairly good control had been achieved with metoprolol and amiodarone. However, over the past several months, he had been experiencing intermittent episodes of atrial fibrillation.

Chest Film Clinic: What caused this man's dyspnea, chest pain, and atrial fibrillation?

December 01, 2006

A 52-year-old man presented to his primary care physician with shortness of breath for 5 days, right-sided lower thoracic back pain, and dry cough. The patient was a 15-pack-year cigarette smoker who had emigrated from China to the United States in 1989. He had no significant history of occupational exposure or tuberculosis. He had no significant weight loss, and his past medical history was otherwise unremarkable.

Chest Film Clinic: What caused persistent cough and dyspnea in this patient?

October 01, 2006

A 65-year-old woman presented to her primary care physician with a 3-month history of worsening cough, now productive of copious blood-tinged secretions. She also reported a recent onset of fever and dyspnea. She denied any chest pain, chills, night sweats, and weight loss.

State-of-the-art airway imaging with CT: Part 3

August 01, 2006

Abstract: A significant advance in CT imaging is the use of 3-dimensional (3D) reconstruction techniques. A 3D reconstruction, for example, permits a volumetric evaluation of the contours of the airways and displays areas of stricture, or narrowing, more effectively than do routine axial images. External 3D rendering, also called CT bronchography, helps reveal complex airway abnormalities and improves the detection of subtle airway stenoses. Although it is primarily an investigational tool, internal 3D rendering (virtual bronchoscopy) has several potential applications, including assessing airway stenoses, guiding transbronchial biopsy procedures, and screening for lung cancer. Multiplanar reformation imaging methods can aid in the assessment of airway stenoses, airway stents, tracheomalacia, and extrinsic airway compression. A review of multiplanar images can also aid in the planning of stent placement or surgery. (J Respir Dis. 2006;27(8):348-352)

Fever and Abdominal Pain in Man With Prior Stab Wounds

July 01, 2006

A 37-year-old man presents with new-onset fever and abdominal pain of several days' duration. What does the PA film show, and what further action would you take to arrive at a diagnosis?