-year-old nonsmoking man was referred to the pulmonary clinic for workup
after abnormal findings on chest radiograph were discovered during his
evaluation for cardiac disease. The patient had a history of mitral
regurgitation and atrial fibrillation, and he had lived in China at an
altitude of 1,900 m all of his life. He traveled to the United States
for evaluation of dyspnea.
Over the past 1 year, he had been hospitalized three times for dyspnea,
which was thought to be secondary to cardiac disease. His exercise
tolerance included two flights of stairs or brisk walking. He had a
chronic cough productive of approximately 50 mL of white sputum per
day. He denied hemoptysis, fever, chills, or sweats.