• Marie-Hélène Lelièvre, Olivia Stiennon, Stephan A Botez, and Bruno-Pierre Dubé.
• Service de Pneumologie, Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
• Chest. 2018 Sep 1; 154 (3): e83-e86.

Case PresentationA 63-year-old man was referred for slowly progressive dyspnea on exertion that had developed over 7 years. Dyspnea was initially only present during high-intensity physical activity, but was now present while walking rapidly on a flat surface. Symptoms were accentuated while supine and when bending forward. He reported respiratory difficulties when submerged in water and a recent onset of slight symmetric lower limb weakness that was only apparent during strenuous physical activity. He also had OSA, which was adequately controlled with continuous positive airway pressure therapy. Neurologic and rheumatologic histories were otherwise unremarkable. He denied any impact accidents or trauma to the cervical spine and prior neck or thoracic surgeries.Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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