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In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.
A 57-year-old man presented to the emergency department with a 2-week history of progressive dyspnea with exertion, edema of the upper and lower legs, a nonproductive cough, and scant hemoptysis. He also reported the occasional passage of bright red blood from his rectum and intermittent nausea and vomiting during the previous 4 days. He reported no recent upper respiratory tract infection, fever,
Commentary
Source Information
From the Department of Medicine (Z.D.G., B.A.Y.), Pathology and Laboratory Services and Department of Pathology (R.F.N.), and the Division of Nephrology (B.A.Y.), Veterans Affairs Puget Sound Health Care System and the University of Washington School of Medicine, Seattle; the American College of Physicians, Philadelphia (S.E.W.); and the Ann Arbor Veterans Affairs Medical Center and the Department of Internal Medicine and Patient Safety Enhancement Program, University of Michigan Health System — both in Ann Arbor (S.S.).
Address reprint requests to Dr. Goldberger at the University of Michigan Health System, Department of Internal Medicine, Division of Cardiovascular Medicine, CVC Cardiovascular Medicine, 1500 E. Medical Center Dr. SPC 5853, Ann Arbor, MI 48109, or at zgoldber@med.umich.edu.
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