Exertional dyspnoea and abnormal chest radiography

doi:10.1136/bmj.b2920

Published 5 August 2009, doi:10.1136/bmj.b2920
Cite this as: BMJ 2009;339:b2920

Endgames

Picture quiz

Exertional dyspnoea and abnormal chest radiography

Luis Corral-Gudino, internal medicine consultant¹, Ramón J Jorge-Sánchez, internal medicine consultant¹, María Borao-Cengotita-Bengoa, internal medicine trainee¹, Judit García-Aparicio, internal medicine consultant ¹, Manuel Cascón-Bueno, cardiology consultant²

¹ Department of Internal Medicine, Hospital los Montalvos, Hospital Universitario de Salamanca, 37192, Salamanca, Spain , ² Department of Cardiology, Hospital Universitario de Salamanca, 37007, Salamanca, Spain

Correspondence to: L Corral-Gudino lcorral@husa.sacyl.es

The first 150 words of the full text of this article appear below.

A 75 year old woman was admitted to hospital because of dyspnoea.She had been well until nine months previously, when she startedto have gradually worsening exertional dyspnoea. On admission,her physical activity was limited. She had no discomfort atrest, but even a very low level of activity caused dyspnoea.She reported no chest pain, orthopnoea, or paroxysmal nocturnaldyspnoea. She had a history of systemic hypertension. She deniedsmoking. Physical examination showed that she had tachypnoeaand a tricuspid systolic murmur. Lung sounds were normal. Electrocardiographyshowed right axis deviation, right ventricular hypertrophy,and atrial fibrillation. Laboratory evaluation showed polycythaemia.Examination of her chest radiograph at admission provided cluesto the diagnosis (fig 1).