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988 radiology.rsna.org n  Radiology: Volume 266: Number 3—March 2013

Case 1951

Farbod Nasseri, MDGeraldine J. Chen, MD Arun C. Nachiappan, MD

Published online10.1148/radiol.12120434 Content code:

Radiology 2013; 266:988–990

1 From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM 360, Houston, TX 77030. Received March 2, 2012; revision requested March 27; revision received June 26; accepted July 12; final version accepted July 24. Address correspondence to F.N. (e-mail: nasseri@bcm.edu).

Conflicts of interest are listed at the end of this article.

q RSNA, 2013

Submit DiagnosisSubmit the most likely diagnosis to http://rsna.org/dxplease (use only for submission of diagnosis). Select the case from the Active Case List for which you are submitting a diagnosis. Only one case, one name, and one diagnosis per e-mail submission. Only those who submit the correct diagnosis will receive CME credit. Multiple diagnoses and multiple submissions will not be considered. Deadline: Midnight U.S. Central Time, May 10, 2013. Answer will appear in the July 2013 issue. Authors wishing to submit cases for Diagnosis Please should first write to the Editor to obtain approval for the case and further information.

History A 48-year-old woman presented to the emergency depart-ment with a 3-month history of increasing left-sided back pain radiating to the left anterior chest. She reported no relief with nonsteroidal antiinflammatory drugs. She also reported chest tightness and dyspnea. She denied fever, nausea, vomiting, unintentional weight loss, or history of trauma to the area. At examination, she was tender to palpation of the left posterior chest wall. She had de-creased range of motion in the back, without any loss of strength. Her white blood cell count and basic metabolic panel were unremarkable. Chest radiography, computed tomography (CT), and magnetic resonance (MR) imaging of the chest were performed. Her pain lessened with nar-cotic medication (Figs 1–4).2013 Diagnosis Please Learning Objectives

In submitting a diagnosis for this case, participants demonstrate the ability to

n Recognize normal and abnormal findings as presented in the diagnostic images

n Identify pathologic conditions indicated in the diagnostic images

n Use clinical reasoning skills to generate a list of differential diagnoses

Accreditation and Designation StatementThe RSNA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The RSNA designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure StatementThe ACCME requires that the RSNA, as an accredited provider of CME, obtain signed disclosure statements from authors, editors, and reviewers for this case. For this journal-based CME activity the editor's and reviewers' disclosures are listed on p 716. Authors' disclosures are listed on at the end of this article.

Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights.

Diagnosis Please: Case 195 Nasseri et al

Radiology: Volume 266: Number 3—March 2013 n radiology.rsna.org 989

Figure 1: (a) Posteroanterior and (b) lateral chest radiographs.

Figure 1

Figure 2: Transverse CT images of the chest obtained after intravenous administration of 150 mL of iohexol (Omnipaque 300; GE Healthcare, Milwaukee, Wis) with (a) soft-tissue and (b) bone window settings.

Figure 2

Diagnosis Please: Case 195 Nasseri et al

990 radiology.rsna.org n  Radiology: Volume 266: Number 3—March 2013

Figure 3: Transverse T2-weighted MR image of the chest obtained with selective fat saturation (repetition time msec/echo time msec, 2550/90.30).

Figure 3 Disclosures of Conflicts of Interest: F.N. No relevant conflicts of interest to disclose. G.J.C. No relevant conflicts of interest to disclose. A.C.N. No relevant conflicts of interest to disclose.

Figure 4: Coronal T1-weighted MR image of the chest with selective fat saturation (550/12.38) after intravenous administration of 15 mL of gadobenate dimeglumine (MultiHance; Bracco Diagnostics, Princeton, NJ).

Figure 4