A 64-Year-Old Woman With Extremity Swelling and Cough

Francisco Aguilar, MD; Carla Arellano Pizano, MD


July 17, 2018

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a Case Challenge, please contact us.


A 64-year-old woman presents to the emergency department with shortness of breath while at rest, nonproductive cough, and lower extremity swelling for the past 2 days. She reports that she was able to walk less than one block and climb less than one flight of stairs because of shortness of breath. She explains that she has to use two pillows at home to sleep. She denies any fever, chills, or chest pain. Her urine output was usual. She further explains that since the day before her symptoms started she was feeling "overwhelmed" because of news about her husband being diagnosed with metastatic colon cancer.

Her past medical history is significant for the following:

Her family history is positive for hypertension and diabetes on both her mother's and father's side. She denies smoking cigarettes, illicit drug use, and significant alcohol use.


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