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An Uncommon Cause of Orthopnea

Author
Dustin L. Norton, MD1 and Jason R. Mock, MD PhD1
1Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina


Case

A 49-year-old man recently treated for pancreatitis presents with progressive dyspnea, orthopnea and new oxygen requirement. Pulmonary exam was remarkable for dullness to percussion and decreased breath sounds at the bases. There was inward movement of the abdominal wall with inspiration. ABG on room air revealed pH 7.43, pCO2 38, pO2 59. BNP was within normal limits and echocardiogram revealed a left ventricular ejection fraction of 55% without diastolic dysfunction.

Image 1
X-Ray
Image 2
Graph

Question

What is the most likely cause of the patient’s dyspnea and orthopnea?

A. Congestive heart failure
B. COPD
C. Diaphragmatic paralysis
D. Interstitial lung disease

Answer