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CASE STUDY:
55-Year-Old With Shortness of Breath and Lower-Leg Swelling
CLINICAL INFORMATION
CHIEF COMPLAINT
Shortness of breath and lower-leg swelling.
HISTORY OF PRESENT ILLNESS
The patient is a 55-year-old woman initially seen in the emergency room with shortness of breath and lower-extremity swelling. She has reported increasing shortness of breath over the last 6 months and a significant increase in the last 3 months. In addition, she reported increasing swelling in both lower extremities. She becomes short of breath from walking across the room, has a mild nonproductive cough, and denies any chest pain. She had no prior history of respiratory problems, but has a 40 pack-year smoking history and is a current smoker.
In the emergency room, a chest radiograph showed diffuse interstitial infiltrates throughout the lungs (Figure 1), which appeared to be new when compared to an x-ray from 5 years earlier. The patient did not present with an acute fever, chills, or sweats. Her weight had been stable or slightly increasing. Her only symptom was the significantly increasing shortness of breath. She had no history of significant dust exposure.
She complained of chronic burning in her eyes, some swelling around her eyes, and extreme fatigue.
She has a history of a C6-7 herniated disk, following an accident 2 years ago. She has been on corticosteroid therapy intermittently since that time and uses oxycodone on a regular basis as pain medication.
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