bax
Forum Senior
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A 55-year-old woman is evaluated because of a 1-year history of decreasing exercise tolerance and, more recently, abdominal distention. Ten years ago, she developed breast cancer that was treated with local excision and radiation therapy. Six months ago, a right pleural effusion was drained, but the effusion recurred within 1 month. The patient has noted occasional episodes of an irregular heartbeat.
On physical examination, her pulse rate is 110/min and irregularly irregular. Blood pressure is 110/60 mm Hg with a decline of 5 mm Hg during inspiration. Cervical and axillary lymph nodes are not enlarged. Jugular venous pressure is 12 cm H2O with a prominent y descent. Breast examination is normal except for a small, well-healed scar on her left breast. There are diminished breath sounds and dullness to percussion at the right base. The left ventricular impulse is nondisplaced. The S1 is variable; the S2 is physiologically split. No gallops or murmurs are heard. The liver is palpable, and the lower extremities show 3+ pitting edema.
Chest radiograph shows a normal cardiac silhouette and a right-sided pleural effusion. The electrocardiogram demonstrates atrial fibrillation, low frontal plane QRS voltage, and nonspecific ST-T–wave changes. A transthoracic echocardi-o-gram shows normal size and function of the cardiac chambers and no pericardial effusion.
Which of the following is the next most appropriate diagnostic test?
A) Liver scan
(B) Bilateral mammography
(C) Magnetic resonance imaging of the heart
(D) Spiral CT of the lungs
(E) Transesophageal echocardiography
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| ing
Forum Guru
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(D) Spiral CT of the lungs
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| drdg
Forum Senior
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D. 
looks like the lung problem.
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| darkhorse
Forum Elite
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i think the picture is something like constrictive pericarditis...may be there is pericardial infiltration by metastatic disease.....MRI??
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| bax
Forum Senior
Topics: 16
Posts: 132
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ans is MRI....they says that bz of previous radiation there is chance of constrictive fibrosis of pericardium....so ..
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