Chaudhry Ammar A, Gul Maryam, Chaudhry Abbas A, Moore William
From the Department of Radiology, Stony Brook University Medical Center, HSC Level 4, Room 120, East Loop Road, Stony Brook, NY 11794 (Ammar A. Chaudhry, Abbas A. Chaudhry, W.M.); and Department of Internal Medicine, Winthrop University Hospital, Mineola, NY (M.G.).
Radiology. 2017 Feb;282(2):602-608. doi: 10.1148/radiol.2016150224.
History A 54-year-old white woman with a history of rheumatoid arthritis who was taking glucocorticoids and methotrexate presented to the emergency department in December with worsening shortness of breath and chest heaviness for 1 week. She reported additional symptoms of weakness, headache, and arthralgia primarily involving her bilateral hands, wrist, ankles, and feet. She denied experiencing fevers, syncope or presyncope, focal neurologic deficits, chest pain, nausea, vomiting, unintentional weight loss, or recent trauma. Additional medical history included hypertension, asthma, degenerative disk disease, and migraine, all of which were reportedly controlled with medications. This patient had a smoking history of 80 pack-years, but she had quit smoking 2 months prior to presentation. She denied abuse of alcohol or recreational drugs and reported she was up-to-date on her immunizations, including those for pneumonia and flu. Family history was pertinent for breast cancer in her mother, sister, and maternal aunt. The patient reported normal findings at screening mammography and colonoscopy. A physical examination was remarkable for slightly asymmetric breath sounds, which appeared to be diminished on the right side. This patient had multiple joint deformities, most notably in the bilateral metacarpophalangeal joints. Initial electrocardiography findings and cardiac biomarkers were negative. Her complete blood count and basic metabolic profile were unremarkable. Posteroanterior and lateral chest radiographs were obtained in the emergency department. Subsequently, computed tomography (CT) of the chest was performed.
病史 一名54岁的白人女性，有类风湿关节炎病史，正在服用糖皮质激素和甲氨蝶呤，12月因气短加重和胸部闷痛1周就诊于急诊科。她还报告了乏力、头痛和关节痛等其他症状，主要累及双手、手腕、脚踝和足部。她否认有发热、晕厥或接近晕厥、局灶性神经功能缺损、胸痛、恶心、呕吐、非故意体重减轻或近期外伤史。其他病史包括高血压、哮喘、椎间盘退变疾病和偏头痛，据报告所有这些疾病均通过药物得到控制。该患者有80包年的吸烟史，但在就诊前2个月已戒烟。她否认酗酒或使用消遣性药物，并报告她的免疫接种是最新的，包括肺炎和流感疫苗接种。家族史方面，她的母亲、姐姐和姨妈均患乳腺癌。患者报告乳腺钼靶筛查和结肠镜检查结果正常。体格检查发现呼吸音略不对称，右侧似乎减弱。该患者有多处关节畸形，最明显的是双侧掌指关节。最初的心电图检查结果和心脏生物标志物均为阴性。她的全血细胞计数和基本代谢指标无异常。在急诊科拍摄了后前位和侧位胸片。随后，进行了胸部计算机断层扫描（CT）。
