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A 67-year-old man was transferred to this hospital with acute respiratory failure.
Four days before admission, the patient had visited his primary care physician because of a three-month history of chest congestion and cough productive of sputum that was initially clear but then became more opaque. His chest felt tight when he breathed deeply, and deep inspirations triggered the cough. During the week before the physician visit, he had had slight nasal congestion, poor appetite, and decreased energy, but no fever, chills, nocturnal sweats, or postnasal drip. His physician obtained a chest radiograph, which showed increased markings at the base
Differential Diagnosis
Pulmonary Edema
Pulmonary Hemorrhage
Acute Eosinophilic Pneumonia
Atypical Infection
Viral Pneumonia
Atypical Bacterial Pneumonia
Acute Fungal Pneumonia
Diffuse Parenchymal Lung Disease
Idiopathic Interstitial Pneumonias
Granulomatous Lung Disease
Hypersensitivity Pneumonitis
Clinical Diagnosis
Dr. David M. Systrom's Diagnosis
Pathological Discussion
Anatomical Diagnosis
Source Information
From the Departments of Pulmonary and Critical Care (D.M.S.) and Radiology (C.W.), Massachusetts General Hospital; and the Departments of Medicine (D.M.S.) and Radiology (C.W.), Harvard Medical School.
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