A case report detailing the presentation of an 86-year-old woman with acute dyspnea, a new pansystolic murmur, and severe cardiopulmonary compromise.
Answers are grounded in this paper and cite their sources.
Normal lung US despite hypoxia suggests non-pulmonary cause in solitary-kidney patient; leaves open need for targeted workup before practice change.
An 86-year-old woman presented to our emergency department for acute dyspnea without chest pain. She had taken amoxicillin/clavulanate 1 g/q12h for acute bronchitis. She underwent a left nephrectomy for cancer twenty years earlier. Blood pressure, heart rate, peripheral oxygen saturation, respiratory rate, and body temperature were 110/60 mmHg, 112 bpm, 90% with a non-rebreather mask (15 L/min), 25 breaths/min, and 36.5°C, respectively. Arterial blood gas documented pH 7.31, pCO2 29 mmHg, pO2 49 mmHg, SatO2 90%, HCO3 14.6 mEq/L, lactates 3.8 mmol/L. Chest examination revealed absent vesicular murmur in the basal regions, crackles in the upper ones, and a pansystolic murmur. A lung ultrasound showed a white lung pattern with a severe pleural effusion and non-collapsible inferior vena cava. Laboratory findings documented WBC 18,610/mm3 with CRP 84 mg/L (n.v.<10), AST 489 U/L (n.v. 11-34), ALT 296 U/L (n.v.<33), and troponin T 5191 ng/L (n.v.<20). ECG and echocardiography are reported in Figure 1 and Video 1, respectively.
No takes yet. Share an insight, caveat, or question.
Poggiali et al. (2025) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: