An unusual cause of dyspnoea in an 83-year-old woman

Abstract

An 83-year-old woman was referred for assessment of rapidly worsening dyspnoea, limiting mobility to 10 yards. She had a history of multiple potential sources of her dyspnoea: coronary artery disease (previous stenting of the right coronary artery, a chronic total occlusion of the mid left anterior descending artery, and 50% stenosis in the circumflex with normal left ventricular function), chronic obstructive airways disease requiring inhaled bronchodilators and steroids, and chronic renal impairment with a mild anaemia. She had also been noted to have a stable aneurysm of the ascending aorta (4.5 cm in diameter) at last angiography 2 years before. Examination at 45° revealed central cyanosis with oxygen saturation of 88% on room air but normal jugular venous pressure and clear lung fields to auscultation. On lying flat, the oxygen saturation improved to 92%. Ventilation perfusion lung scan indicated …