Abstract
A 79-year-old ex-smoker was admitted because of cyanosis, following a recent chest infection. He described longstanding mild exertional dyspnoea, attributed to chronic obstructive pulmonary disease (COPD), for which he was prescribed inhalers and long-term steroid therapy. His co-morbidities included hypertension, renal impairment, polymyalgia and three repairs of an infrarenal aortic aneurysm. He appeared cushingoid and cyanosed, with a respiratory rate of 22/min, oxygen saturations 72%, blood pressure 95/50 mmHg and heart rate 95/min. His arterial blood gas analysis revealed pH 7.45, pO2 5.1 and pCO2 4.9 mmHg. Chest X-ray and CT pulmonary angiogram revealed mild emphysematous change, but no evidence of pulmonary embolism (PE). As smaller subsegmental emboli could not be excluded, anticoagulation was initiated. Transthoracic echocardiography (TTE) was normal other than a dilated aortic root. Notably, both right heart function and pulmonary artery pressure were normal. Throughout his admission frequent emergency …
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