Case presentation A 60-year-old woman with worsening dyspnea when resting presented to the emergency department. She had no fever, chest pain, expectoration, syncope, or constitutional symptoms.
Medical history Non-smoker Morbid obesity Poorly managed asthma Hypertension Type 1 diabetes Diabetic nephropathy Dyslipidemia Chronic anemia Physical examination Body mass index – 46 kg/m 2 Jugular vein distention Imperceptible heart sounds Vesicular breath sounds – Reduced on the left side of the chest Chest X-ray Cardiomegaly Massive left pleural effusion ## Blood test ## Hemoglobin – 8.3 g/dL Mean corpuscular volume (MCV) – 73 fL Lactate dehydrogenase (LDH) – 525 U/L D-dimer – 5400 ng/mL Albumin – 3g/dL C-reactive protein (CRP) – 3 mg/dL Arterial blood gas (inspired oxygen [FiO 2 ] 0.21) – pH 7.36 Partial pressure of carbon dioxide (PCO 2 ) – 49 mmHg Partial pressure of oxygen (PO 2 ) – 67…
