Quiz page answers October 2004   American Journal of Kidney Diseases  Volume 44, Issue 4, Pages e47-e49 (October 2004) DOI: 10.1053/j.ajkd.2004.04.054 Copyright © 2004 Terms and Conditions

Figure 32A What do you observe on this chest x-ray image of the patient? This x-ray shows a pulmonary consolidation in the upper zone of the right lung and the typical appearance of pneumopericardium. American Journal of Kidney Diseases 2004 44, e47-e49DOI: (10.1053/j.ajkd.2004.04.054) Copyright © 2004 Terms and Conditions

Figures 32B-D What do you observe on these computed tomographic images? These computed tomographic images show the presence of a nodule in the right upper lobe, pneumomediastinum, the presence of air in the fissure (pneumothorax), and pneumopericardium, but no bronchopericardial fistula could be shown. American Journal of Kidney Diseases 2004 44, e47-e49DOI: (10.1053/j.ajkd.2004.04.054) Copyright © 2004 Terms and Conditions

Figures 32E and F What do you observe on the follow-up computed tomographic images? Graft dysfunction was caused by tacrolimus toxicity, with an increase in serum tacrolimus level to 25 ng/mL, and responded well to a reduction in doses of tacrolimus. The dose of azathioprine also was reduced to 1.5 mg/kg/d. The patient’s follow-up computed tomographic images showed that pneumomediastinum, pneumopericardium, and pneumothorax resolved, but 2 nodular lesions transformed to the cavities after 30 days of liposomal amphotericin B therapy. Eight months later, the patient remains asymptomatic with stable renal function (serum creatinine, 1.9 mg/dL [168 μmol/L]) and no evidence of recurrent infection. American Journal of Kidney Diseases 2004 44, e47-e49DOI: (10.1053/j.ajkd.2004.04.054) Copyright © 2004 Terms and Conditions