Skill Checkup: A 59-Year-Old Man With Dyspnea on Exertion and a Nonproductive Cough

Zab Mosenifar, MD


March 28, 2023

A 59-year-old man in the US, a farmer, presents with dyspnea on exertion and a nonproductive cough, which have been present for 6 months. Height is 5 ft 10 in, and weight is 178 lb (80.74 kg; body mass index, 25.5 kg/m2). Physical examination shows finger clubbing and Velcro-like crackles in his lungs. Oxygen saturation is 87%. He was taking an immunosuppressant for about 4 months, but the symptoms progressed.

Pulmonary function testing demonstrates low residual volume, low forced vital capacity, low total lung capacity, decreased diffusing capacity of the lungs for carbon monoxide, and poor lung compliance, consistent with a restrictive pattern.

Chest high-resolution CT shows architectural distortion with reticulation, honeycombing, ground-glass attenuation, and a usual interstitial pneumonia pattern.


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