78-year-old female is admitted to the hospital for treatment of progressive exertional dyspnea. She has a chronic dry cough which has not changed recently. She denies having any chest pain or hemoptysis. She is not aware of any prior evaluation for her lungs, however review of the record indicates she has had an abnormal CT scan particularly in the right lower and right middle lobe dating back 2 years ago.
Biopsies were inconclusive. She is a non-smoker. PMH: Severe end-stage cardiomyopathy with ejection fraction of 15% Physical examination: Cachectic in NAD VS 36.8-20-76-143/80 SpO2 96% on 2L HEENT: mild JVD Lungs: Harsh Velcro-like rales heard on the left almost to the scapula tip with a few rales at the right base CVS: Heart sounds are distant Abdomen: soft, nontender Extremities: No c/c/e CXR showed a progression of bilateral pulmonary infiltrates, especially on the right (Images…
