Radiology Review

The Not-So-Routine Physical

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The Not-So-Routine Physical image

A 60-year-old woman wants to establish care as a new patient at your clinic. She pre­sents for an annual physical and has no current complaints.

Her medical history is significant for hypertension and remote uterine cancer, which was treated with a hysterectomy. She does report smoking a half-pack to one pack of cigarettes per day for “about 30 to 40” years.

Vital signs are normal. Overall, the complete physical examination yields no abnormal findings. Routine bloodwork, 12-lead ECG, and a chest radiograph are ordered. The last is shown. What is your impression?


The Not-So-Routine Physical image


The radiograph shows a moderate-size mass, measuring about 5 × 3 cm, at the medial portion of the right upper lobe, within the paratracheal region. This lesion should be treated as a neoplasm until proven otherwise. Contrast-enhanced CT is warranted, as well as prompt referral to a cardiothoracic surgeon.

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