Editor’s note: In this occasional feature, we first present a series of images (this page) for your review, and then a brief discussion of the findings and diagnosis. Before you read the discussion, examine these images carefully and draw your own conclusions.
A 39-year-old white woman with a three-year history of seropositive rheumatoid arthritis stable on weekly injections of methotrexate 20 mg and injections every other week of adalimumab 40 mg presented with shortness of breath and tachycardia. She had no fevers, weight loss or cough, and had never smoked. Her past medical history was noncontributory. She was tachycardic (109/min) with the remaining vitals, as well as respiratory, cardiovascular and abdominal exam normal. The following CT angiogram was obtained.