Sonia Arunabh, MD

September 14, 2005

A 30-year-old man presented to the emergency department with new-onset seizures. His past medical history included loss of vision for 1 year, deafness, and osteomyelitis of the mandible.

September 14, 2005

A 25-year-old man, who was an injection drug user, presented with a several-day history of dyspnea and fever. He complained of excessive malaise, fatigue, and weight loss but denied any hemoptysis. The examination of the lung revealed bilateral crackles in both lower zones.

September 14, 2005

A 67-year-old man had been hoarse since undergoing a thyroidectomy for carcinoma nearly 3 months ago. Indirect laryngoscopy now confirmed paralysis of the right vocal cord, which was fixed in the paramedian position. The left vocal cord appeared normal.

September 14, 2005

A 52-year-old woman who was undergoing chemotherapy for lymphoma was admitted to the hospital with fever of a few days' duration. The patient had smoked cigarettes for many years; she had no history of deep venous thrombosis.

September 14, 2005

A 40-year-old woman with a history of amenorrhea complained of recent headaches and galactorrhea for the last 6 months. A neurologic work-up revealed bitemporal hemianopia, and a radiograph of the skull suggested an enlarged sella turcica. A large pituitary adenoma disclosed by an MRI and a serum prolactin level of 360 µg/L led to a diagnosis of prolactinoma.

September 14, 2005

A mass on the right side of her face-over the right parotid region-had been growing for the past 4 years, according to this 65-year-old woman. There was no evidence of facial nerve involvement.

September 14, 2005

Having been treated for pulmonary tuberculosis (TB) 25 years earlier, a 60-year-old man (a nonsmoker) now complained of a chronic cough. The cough was occasionally accompanied by yellowish sputum but no hemoptysis. Examination revealed persistent coarse crackles in the right posterior hemithorax, and the x-ray study seen here established the diagnosis of cystic bronchiectasis.

September 14, 2005

An 85-year-old man was admitted to the hospital with a cough and shortness of breath of 1 week's duration and a fever and increased sputum production for 2 days. His history included renal cell carcinoma and metastatic renal cancer for 2 years. The patient had smoked cigarettes for 30 years. He had lost 30 lb during the last few months.

September 14, 2005

An 82-year-old man underwent right pneumonectomy for squamous cell carcinoma of the right lower lobe. His postoperative course was complicated by prolonged air leak from the chest tube, suggesting a bronchopleural fistula secondary to leakage from the bronchial stump. Over the ensuing 3 months, the air leak slowly decreased, but the patient was left with a nonhealing scar on the anterior thoracic cavity, as seen here.

September 14, 2005

A 42-year-old woman came to the emergency department because of hematuria for 1 day, a low-grade fever, and weight loss over the past 2 months. She denied having any abdominal pain or urinary problems. Pallor was the only noteworthy physical finding.