Sonia Arunabh, MD

September 14, 2005

A 40-year-old man, originally an Ohio resident, underwent a chest x-ray study during medical clearance following surgery to repair a hernia. Although the patient had no pulmonary symptoms, the film showed multiple small, punctate calcifications in both lung fields.

September 14, 2005

A 72-year-old nursing home resident was hospitalized with fever, chills, and rigors of 2 days' duration. The nursing home staff reported the patient had dysphagia after a recent stroke.

September 14, 2005

A 42-year-old woman complained of facial puffiness, fullness, and redness for 2 weeks, which were gradually becoming more severe. She also noticed a sensation of “heaviness” in her head. The patient had no significant past medical history. She denied having a cough, shortness of breath, hoarseness, allergies of any kind, and neurologic deficits. Her weight and appetite were unchanged. She had smoked a pack of cigarettes every day for the past 20 years.

September 14, 2005

The significant palmar erythema seen on the hands of a 60-year-old man with alcoholic cirrhosis is a sign of underlying chronic liver failure.

September 14, 2005

A 72-year-old woman who was being evaluated for medical clearance for an elective cholecystectomy was asymptomatic, except for biliary colic. She had had pulmonary tuberculosis (TB) 40 years earlier, for which she had undergone surgery on the right hemithorax-a fact borne out by a thoracotomy scar. An x-ray film of her chest, shown here, demonstrates numerous plastic balls in the right thoracic cavity. This is an example of collapse therapy for pulmonary TB, which was practiced years ago, before the availability of effective antituberculous medications.

September 14, 2005

Bilateral swelling and pain of the distal interphalangeal (DIP) joints for several months brought this 65-year-old woman to her physician. She complained also of stiffness in the region of the DIP joints when she arose in the morning and after short periods (less than 15 minutes) of inactivity. A history such as this, in conjunction with the appearance of the patient's hand, is typical of Heberden nodes, which are a manifestation of osteoarthritis (OA).

September 14, 2005

A 65-year-old man was hospitalized with dyspnea and fever of a few days' duration. He complained of excessive malaise, fatigue, and weight loss but denied any hemoptysis. The patient had a history of alcohol abuse.

September 14, 2005

During the past few months, a 50-year-old woman had experienced cough, dyspnea, mild hemoptysis, and a 30-lb weight loss. She had no fever, chills, or rigors. The patient had smoked cigarettes for 30 years.

September 14, 2005

A 67-year-old man with a 5-month history of cough, shortness of breath, and pain in the left anterior chest wall sought medical evaluation. The patient denied fever, chills, and hemoptysis. He reported a recent weight loss of 25 lb. The patient had smoked cigarettes for 37 years.

September 14, 2005

A 48-year-old man complained of difficulty in swallowing both solid food and liquids. The dysphagia began several years earlier and had become increasingly severe and more frequent over the past 2 to 3 years. Vague heartburn without reflux and frequent regurgitation were also troublesome.