Chest
Pulmonary Physiologic Test of the MonthThe Invaluable Pressure-Volume Curve
Section snippets
Case Report
The patient was a 43-year-old man who had been referred for the evaluation of dyspnea on exertion. One year before this evaluation he was in excellent health and had successfully hiked the entire length of the Long Trail in the Green Mountains of Vermont (a total of 265 miles). Six months before referral he observed that he was unable to keep up with his friends while snowshoeing because of dyspnea, which gradually worsened. At the time of referral, he was virtually disabled and was unable to
Discussion
When this patient presented with significant dyspnea on exertion, exercise desaturation, and a restrictive pattern of spirometry, we expected to find an abnormality on CT scan, but we did not. The spirometry data and the CT scan seemed to be contradictory, so we were faced with a diagnostic dilemma. Should we proceed to a lung biopsy even though the patient had a normal or near normal CT scan? The consensus was that we should obtain a more clear-cut indication for a lung biopsy before incurring
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