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Case Records of the Massachusetts General Hospital
Weekly Clinicopathological Exercises
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Volume 347:2149-2157 December 26, 2002 Number 26
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Case 40-2002 — A 56-Year-Old Man with Rapidly Worsening Dyspnea
Michelle Ng Gong, and Eugene J. Mark

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Presentation of Case

A 56-year-old man was admitted to the hospital because of rapidly progressive dyspnea and pulmonary abnormalities.

The patient had been well until about two weeks earlier, when he stopped smoking because he "felt like it"; he had a 100-pack-year history of cigarette smoking. One week later, he began to experience substernal heaviness without radiation, sweating, or nausea and had increasing dyspnea on slight exertion, with a progressive, nonproductive cough. The findings on a chest radiograph were abnormal, and he was admitted the same day to the hospital.

The patient had a history of diabetes mellitus with nonketotic hyperosmolarity, which had . . . [Full Text of this Article]

Differential Diagnosis

Chronic Interstitial Lung Disease

            Idiopathic Pulmonary Fibrosis

            Nonspecific Interstitial Pneumonia

            Desquamative Interstitial Pneumonia

            Langerhans'-Cell Histiocytosis

Collagen Vascular Disease

Acute Interstitial Lung Disease

            Acute Respiratory Distress Syndrome

            Acute Interstitial Pneumonia

            Bronchiolitis Obliterans with Organizing Pneumonia

            Acute Eosinophilic Pneumonia

            Accelerated Variant of Usual Interstitial Pneumonitis

Acute Exacerbation of Idiopathic Pulmonary Fibrosis

Clinical Diagnosis

Dr. Michelle Ng Gong's Diagnosis

Pathological Discussion

Anatomical Diagnosis


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