1. Quiz page answers October 2004
American Journal of Kidney Diseases 
Volume 44, Issue 4, Pages e47-e49 (October 2004)
DOI: /j.ajkd
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2. 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  , e47-e49DOI: ( /j.ajkd )
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3. 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  , e47-e49DOI: ( /j.ajkd )
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4. 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  , e47-e49DOI: ( /j.ajkd )
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