Chest
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A 37-year-old man attended a medical clinic at the confluence of the Appalachian and the St. Lawrence Valley after 2 weeks of coughing greenish sputum and progressive dyspnea on exertion. In addition, he reported fatigue, fevers, and chills. ⋯ He returned to the emergency room 1 week later with mild hypoxemia, persisting fever, and a chest radiography consistent with lobar pneumonia. The patient was admitted to his local community hospital, and broad-spectrum antibiotics were added to the regimen. Unfortunately, his condition deteriorated over the following week, and he experienced hypoxic respiratory failure for which he required mechanical ventilation before his transfer to our medical center.
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A 52-year-old White man, who currently smokes, was admitted to the medical ICU with worsening shortness of breath. The patient was dyspneic for a month and had been clinically diagnosed with COPD by his primary care doctor and started on bronchodilators and supplemental oxygen. He had no known medical history or recent illness. ⋯ He denied cough, fever, night sweats, or weight loss at the time of admission. There was no history of work-related or occupational exposures, drug intake, or recent travel. Review of systems was negative for arthralgia, myalgia, or skin rash.
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A 33-year-old teacher from Ghana with no medical comorbidities and no relevant family history came to our pulmonology department with progressive difficulty in breathing, wheezing, and stridor for 6 months. Similar episodes had been treated previously as bronchial asthma. She was being treated with high-dose inhaled corticosteroids and bronchodilators but had no relief. ⋯ There was a hard, minimally tender, nodular swelling of 3 × 3 cm in the midline neck felt just below the cricoid cartilage, moving with deglutition and protrusion of the tongue, with no retrosternal extension. There was no cervical or axillary lymphadenopathy. Laryngeal crepitus was present.