What does acute dyspnea hide?

Abstract

Case presentationDr. Giovanna Squiccimarro In December 2009, a previ-ously healthy 48-year-old man was admitted because ofhypertensive crisis and bilateral diffuse ground-glassshadows on the chest X-ray study.He presented at the Emergency Department (ED) com-plaining of worsening dyspnea.The respiratory rate was 35 breaths/min and SpO2 93%at pulse oximeter. His blood pressure (BP) was 220/120mmHg and the heart rate 120 beats/min.He was overweight, afebrile and diaphoretic. He had ahistory of alcohol and tobacco abuse (more than 20 ciga-rettes/day). He denied use of any medications, and reportedthat mild dyspnea and fever (TA 39 C) acutely began3 weeks prior. The fever resolved without any therapy in afew days but a mild dyspnea persisted.Ten days prior to admission, dyspnea was still presentand an isolated hemoptysis occurred.Normal lung breath sounds and a 3/6 heart systolicmurmur were heard on the examination. The electrocar-diogram (EKG) showed sinus tachycardia, right bundle-branch block and S1–Q3 pattern.Arterial blood gas (ABG) analysis while breathing roomair showed pH 7.47, PaO2 57 mmHg, pCO2 33 mmHg,HCO3- 25.4 mmol/L. Laboratory tests were normalexcept for WBC count 10,200/mmc (N = 80%), C-RP1.31 mg/dL (normal range\0.5), creatinine 1.4 mg/dL,K