Clinical History: A 47-year-old woman presented for medical evaluation prior to transsphenoid hypophysectomy for pituitary adenoma for Cushing syndrome. The patient had an extensive past medical history, including kidney minimal change disease treated with corticosteroids between 5-7 years previously (no longer on corticosteroid therapy), type II diabetes mellitus, focal segmental glomeruloscleroosis on renal biopsy, morbid obesity, gout, obstructive sleep apnea on continuous positive airway

more »

... ssure (CPAP) supplemented with oxygen for the previous 8 years, hypertension, and recent-onset atrial fibrillation, as well as a history of several pneumonias, perhaps related to chronic immunosuppression. Her past surgical history included bilateral partial knee replacement, lower extremity vein ablation, and breast reduction. Her medication list was extensive, including allopurinol, anti-hypertensives, anti-depressants, colchicine, oxygen, and Tacrolimus, among others, including over-the-counter medications. Laboratory data, include white blood cell count, coagulation profile, and serum chemistries were within normal limits. Oxygen saturation on room air was 95%. Frontal and lateral chest radiographs (Figure 1 ) were performed. A previous chest radiograph performed 2 years earlier is presented for comparison ( Figure 2 ). Figure 1. Frontal (A) and lateral (B) chest radiography.