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Orthopnea in a Patient with Doxorubicin Exposure

Author
Jeffrey Halleck, MD
Internal Medicine Resident
University of Utah


Case

History of Present Illness: A 34 year old male with history of Stage 1BX mediastinal B-cell lymphoma treated with 6 cycles of R-CHOP followed by radiotherapy 8 years ago presents with a 2 month history of increasing abdominal girth, cough, dyspnea on exertion, and orthopnea.

Past Medical History: B-Cell lymphoma, chronic pancreatitis, alcoholism, atrial septal defect
Vital Signs: Respiratory rate: 27/min, pulse 112/min, BP 95/60 mmHg, pulse oximetry 91% on 4 liters oxygen via nasal cannula.

Physical Examination: JVP 15cm, bibasilar end-inspiratory rales extending to lower scapular border bilaterally, accessory muscle use, liver span 4cm below costal margin, 1+ lower extremity edema to knees.

EKG: Sinus tachycardia, left axis deviation, left ventricular hypertrophy with repolarization abnormalities.

Chest Radiograph: Findings include a single lead defibrillator, cardiomegaly, prominent interstitial markings bilaterally, central peri-hilar opacities, and mild thickening of the minor fissure.

Bedside Lung Ultrasonography: Using either a low-frequency phased-array probe or a high-frequency linear probe, the following finding is present bilaterally on atleast two locationas on each side.

Ultrasound

Question

Based on his history and lung ultrasound findings, which one of the following is likely to explain his dyspnea?

A. Pneumothorax
B. Pneumonia
C. Pulmonary edema
D. ARDS

Answer