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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 46-Year-Old Man With Dyspnea and Left Diaphragm Paralysis

Khalil Diab, MD; Riley J. Snook, MD; Mark Farber, MD, FCCP
Author and Funding Information

Affiliations: From the Department of Medicine (Drs. Diab and Farber), Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, and the Department of Neurology (Dr. Snook), Indiana University School of Medicine, Indianapolis, IN.

Correspondence to: Khalil Diab, MD, 340 West 10th St, Suite 6200, Indianapolis, IN 46202-3082; e-mail: kdiab1977@gmail.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(6):1690-1693. doi:10.1378/chest.09-1072
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Extract

A 46-year-old man was referred because of increasing shortness of breath. His symptoms started 1 year prior after he fell while working in Iraq as a contractor. Progressively increasing shortness of breath developed on exertion with a nonproductive cough, and he could walk only 50 ft on presentation. Additional symptoms were occasional dysphagia, diplopia, mild short-term memory problems, morning headaches, hypersomnolence, and severe fatigue toward the end of the day. His medical history included coronary artery disease, obesity, obstructive sleep apnea, hypertension, dyslipidemia, and chronic low back pain, and he was an ex-smoker of 50 pack-years. The patient was on leave from work secondary to his shortness of breath and back pain. He was receiving the following medications: morphine sulfate, sustained release; cyclobenzaprine; tramadol; atorvastatin; clopidogrel; metoprolol; furosemide; and lansoprazole.

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