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Pulmonary and Critical Care Pearls |

A 45-Year-Old Man With Slowly Progressive Shortness of Breath*

Robert Vassallo, MD; Marie Christine Aubry, MD; Jeffrey L. Myers, MD, FCCP; Charles F. Thomas, MD
Author and Funding Information

*From the Thoracic Diseases Research Unit (Drs. Vassallo and Thomas), Division of Pulmonary, Critical Care and Internal Medicine, and the Department of Anatomic Pathology (Drs. Aubry and Myers), Mayo Clinic and Foundation, Rochester, MN.

Correspondence to: Charles F. Thomas, MD, Thoracic Diseases Research Unit, 601A Guggenheim Building, Mayo Clinic and Foundation, Rochester, MN 55905; e-mail: thomas.charles@mayo.edu



Chest. 2000;118(6):1822-1825. doi:10.1378/chest.118.6.1822
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Extract

A 45 -year-old man was referred to our institution for further evaluation of slowly progressive dyspnea on exertion. His symptoms started 3 years prior to presentation, and consisted of episodes of shortness of breath related to exertion. He did not complain of cough, fever, hemoptysis, wheeze, or chest pain. He was initially treated with several antiasthmatic medications, including inhaled bronchodilators, inhaled steroids, and theophylline, without any relief of symptoms. Subsequently, the shortness of breath became progressively worse over time. Due to lack of improvement with empiric therapy, a comprehensive medical evaluation was performed by the primary physician. Findings on initial testing revealed arterial hypoxemia on arterial blood gas analysis, and a markedly reduced diffusing capacity on pulmonary function testing. Chest radiography, ventilation/perfusion scanning, lower-extremity Doppler ultrasound studies, and echocardiography were all normal. Following this evaluation, the patient was referred to our institution for further diagnostic evaluation.

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