James D. Collins, MD

This 63-year-old man with diabetes was hospitalized for bronchitis in a local community hospital and found to be anemic.

This is a 12-year-old male water polo player who presented with intermittent headaches associated with black floaters in his visual fields and loss of vision

A 17-year-old Filipino female in the southern San Joaquin Valley of California presented with a 3 week history of progressive dyspnea on exertion and orthopnea accompanied by fever, chills, pleuritic chest pain, weight loss, and general debilitation.

A mother brought her 1-year-old daughter to the emergency department and reported that the child had swallowed a coin. She had vomited once without recovery of the coin. The mother said the baby had not been coughing or wheezing and had no respiratory distress, but she refused to eat.

A 28-year old man comes in who recently arrived in southern California from South America and suddenly developed a "cold." His symptoms included productive cough, shortness of breath, chest pain, fever, weakness and malaise. He also reported unexplained weight loss. Sputum and blood specimens were obtained for acid-fast smear examination and culture. A single posterior-anterior chest radiograph was obtained as part of his initial evaluation.

The patient is a 48-year-old male with "heart trouble" since the age of 6 years, after having rheumatic fever. He was treated with digitalis and diuretics until he was 31 years of age when he was admitted for heart failure and underwent closed commissurotomy.

One day following sigmoidoscopy for an anal stricture, this 61-year-old obese woman was admitted to the emergency department in shock. Earlier that morning, she had a barium enema without evidence of free air inferior to the diaphragm. Acute abdominal pain developed several hours later.

This 27-year old female medical student with recently diagnosed hypertension is seen following a chest x-ray in work up of a positive PPD. Upon questioning, the patient notes what she described as "gray-out spells" when tired and leg numbness with exercise after periods of sitting.

This is 52-year-old woman presented to the emergency with department with a 4-day history of upper abdominal cramping pain, nausea, vomiting, and distended abdomen.

This is a 23-year-old female admitted for the first time who provides the history of congenital right chest wall deformity, right hypoplastic breast and absent right pectoralis muscles (1). Preliminary upright PA, lateral and right posterior oblique radiographs were obtained to evaluate the osseous and soft tissues of the thorax prior to cosmetic surgery and repair. No past history was made available.

Slam dunking basketball player reports pain in his left foot and undergoes exams to determine the cause of the problem

This is a 60-year-old male with a 30-year history of bone pain. He had bilateral hip replacements 2 and 3 years earlier with no complications, but he has continued to have severe back pain.

Left untreated or inadequately treated, syphilis may cause tertiary cardiovascular disease, one form of which is syphilitic aortitis.

Hamartomas can be found incidentally via chest radiograph, a cost-effective screening tool that should always be part of the initial evaluation in patient care.

A radiograph to detect the presence of a cervical rib should be mandatory prior to thoracic outlet syndrome surgery as a baseline study.

When a patient's presenting complaint is chest pain, consider plain radiographs directed to the area of pain and do not forget to look at the bones.

Since pain typically presents before bone lesions are displayed on radiographs, a true diagnosis may be overlooked and the early stages can be easily missed.

As any pulmonary disease can mimic sarcoidosis, its diagnosis must be supported by all clinical methods involving follow-up radiographs and biopsy.

Though a diagnosis can be made from a single plain X-ray film, multiple views are often recommended, especially when the anatomy is so small that it is difficult to visualize a fracture.

The statement that there is no rule without exception is arguably more true in cases of sarcoidosis than in almost any other condition.

A combination of Gaucher's disease and sickle cell anemia in an 11-year-old boy presenting with leg pain may have been the secret to his survival for more than 28 years.

A diagnostic radiologist misinterprets a month-old infant's anterior-posterior (AP) chest radiograph and AP and lateral skull radiographs as being "positive" for bilateral parietal bone fractures.