Case 42-1992

Presentation of CaseA 59-year-old woman was admitted to the hospital because of progressive dyspnea.The patient was in excellent health until four or five years earlier, when she began to experience exertional dyspnea that gradually worsened. Seven months before admission she discontinued a 50—pack-year habit of cigarette smoking, with transitory improvement. Three or four months later the dyspnea began to worsen progressively and was accompanied by fatigue, and she entered another hospital. The results of cardiopulmonary laboratory studies are presented in Table 1. An x-ray film of the chest showed a diffuse, bilateral interstitial infiltrate. A ventilation—perfusion scan indicated a . . .