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Assembly

Chronic Cough and Dyspnea

Authors
Mandeep Singh, MD1; Evgeniya Angelova, MD2, PhD; Shawn Nishi, MD1
1Department of Internal Medicine, Division of Pulmonary Critical Care and Sleep Medicine
2Department of Pathology
University of Texas Medical Branch
301 University Boulevard
Galveston, TX 77555-0561


Case

A 65-year-old Caucasian female is referred to the pulmonary clinic with progressively worsening of productive cough and shortness of breath for 3 months. She had failed trials of antibiotics, nasal steroids and antihistamines. She denies GERD, history of asthma or recent illness or travel. She is a lifelong non-smoker and has a desk job. Initial spirometry revealed FEV1 2.03 L (84% predicted), FVC 2.51 L (80% predicted), FEV1/FCV 0.81 and exertional desaturation requiring 4L nasal cannula to maintain SpO2 greater than 90%. Initial (Figure 1) and repeat (Figure 2 and 3) CT thorax images are shown. Our patient was referred for VATS lung biopsy (Figure 4).

Figure 1
CT Thorax Images
Figure 2
CT Thorax Images
Figure 3
CT Thorax Images
Figure 4
VATS Lung Biopsy

Question

What is the most likely diagnosis?

A. Non-specific interstitial pneumonia
B. Cryptogenic organizing pneumonia
C. Hypersensitivity pneumonitis
D. Desquamative interstitial pneumonia

Answer