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Bloated 2

Step 1: View clinicals

A 60 year old caucasian man presents with dyspnea at rest for 1 month. Close questioning reveals a history of exertional dyspnea for 2 years (which he attributed to 'aging'), and ankle swelling for the last 3 months. He has smoked for a total of 62 pack years, and has not been medically evaluated for many years.

Step 2: Order all relevant investigations

Chest X-Ray

The lung fields are hyperinflated. A prominent pulmonary conus is noted.

CT Chest

The CT scan shows emphysematous changes in both lungs. There is marked dilation of the right main pulmonary artery, pulmonary arterial trunk, and right ventricle.


FEV1 = 50% of predicted value FEV1/FVC = 0.62 Analysis: suggestive of an obstructive pattern

ECG + Echocardiogram

The ECG shows tall, narrow, peaked P waves in the inferior leads; tall R waves in the right-sided chest leads; and deep S waves in the left-sided chest leads. The echocardiogram shows right atrial and right ventricular hypertrophy, along with pulmonary hypertension. The left ventricular ejection fraction is normal.

Step 3: Select appropriate management

ACE Inhibitors
Beta Blockers
Inhaled Bronchodilators

Score: ★★☆