Chest
Volume 104, Issue 3, September 1993, Pages 927-929
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Pulmonary and Critical Care Pearls
Diffuse Pulmonary Infiltrates and Respiratory Failure Following 2 Weeks of Dyspnea in a 45-Year-Old Woman

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Section snippets

Physical Examination

Vital signs: temperature, 37°C; pulse, 100/min; respirations, 28/min; BP, 150/90. General: obese woman in severe respiratory distress. Chest: diffuse crepitant rales. Cardiac: regular tachycardia without gallop or murmur. Abdomen: soft without organomegaly. Extremities: no clubbing, trace ankle edema.

Laboratory Findings

Hematocrit, 45 percent; WBC, 16,700/μl, with 65 percent polymorphonuclear leukocytes, 24 percent lymphocytes, and 2 percent eosinophils; prothrombin time and partial thromboplastin time, normal.

CLINICAL PEARLS

  • 1.

    Several causes of interstitial lung disease may occasionally have a relatively acute presentation, follow a rapid course, and mimic atypical infectious pneumonias. Such presentations frequently cause a delay in diagnosis.

  • 2.

    In addition to excluding an infectious disorder, cellular analysis of the bronchoalveolar lavage specimen may suggest the underlying diagnosis.

  • 3.

    Analysis of lung tissue, preferably obtained by open or thoracoscopic lung biopsy, will distinguish between the causes of acute

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Supported by National Heart, Lung, and Blood Institute SCOR grant No. 27353.

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