Pulmonary
The Southwest Journal of Pulmonary and Critical Care publishes articles broadly related to pulmonary medicine including thoracic surgery, transplantation, airways disease, pediatric pulmonology, anesthesiolgy, pharmacology, nursing and more. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.
June 2023 Pulmonary Case of the Month: An Invisible Disease
Pulmonary Department
Mayo Clinic Arizona
Scottsdale, AZ USA
History of Present Illness
A 78-year-old man presented to the Emergency Department on April 7 for shortness of breath and weakness over the last 2 weeks. He was in good health prior to an outside hospitalization March 29-April 3 for pneumonia and a possible non-ST-elevation myocardial infarction (elevated troponins). He had a bronchoscopy during his recent outside hospitalization without specific pathogen identified but was treated with antibiotics and discharged on levofloxacin. Since his hospital discharge 4 days previously he feels weaker and increasingly short of breath. He is short of breath even walking around his home. He denies fever or a productive cough.
Past Medical History, Family History and Social History
- Atrial fibrillation, s/p ablation. On Eliquis.
- Prior renal cell carcinoma, s/p resection, no recurrence
- DM Type 2
- GERD
- OSA
- Essential tremor
- Never smoked
Medications
- Apixaban
- Aspirin
- Atorvastatin
- Flecanide
- Insulin
- Levofloxacin
- Lisinopril
- Pantoprazole
- Tamsulosin
Physical Examination
- General: The patient looks comfortable and is in no distress
- Vital Signs: BP 110/62 O2 Sat 94% on room air
- CVS: Heart sounds are regular
- Lungs: Clear to auscultation
- Abdomen: Soft, nontender, bowel sounds present
- Extremities: No edema
- Neuro: Alert and oriented
- Skin: Warm and dry, no rashes
Chest X-ray
A portable chest X-ray was performed (Figure 1).
Figure 1. Portable chest X-ray obtained in the emergency department.
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