Chest
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A 58-year-old man presented to us with a 1-week history of high-grade fever and progressive dry cough. Four weeks before his presentation, he was diagnosed with COVID-19 infection and needed non-ICU hospital admission with no supplemental oxygen requirements for 6 days and was treated with a 5-day course of remdesivir and 3 weeks of dexamethasone. ⋯ He did not complain of any shortness of breath, weight loss, or loss of appetite. He was never a smoker and denied any alcohol use.
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In an asymptomatic 19-year-old who regularly underwent cardiopulmonary fitness testing for national lifeguard-accreditation, 129Xe MRI unexpectedly revealed an abnormally augmented RBC signal and RBC-to-alveolar-capillary-tissue ratio with spatially homogeneous ventilation, tissue barrier, and RBC images. Pulmonary function was normal, but cardiopulmonary follow-up including transthoracic and transesophageal echocardiogram, heart catheterization, and contrast-enhanced cardiac CT imaging led to the diagnosis of a large (20 × 27 mm) secundum atrial septal defect (ASD) with a net right-to-left shunt (Qp:Qs = 0.5) and normal pulmonary pressures. ⋯ Unlike ASD cases that present with dyspnea and exercise limitation, this 129Xe MRI abnormality was detected in an asymptomatic teenager. This is the first report of asymptomatic adult congenital heart disease diagnosed subsequent to novel 129Xe MRI that led to early intervention, avoiding long-term complications of cyanosis, including ventricular fibrosis and thromboembolic and bleeding risks.
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Case Reports
A 73-Year-Old Woman With Progressive Shortness of Breath and Right-Sided Hemithorax Opacity.
A 73-year-old frail woman presented with 3 months of progressively worsening exertional dyspnea, mild cough with white mucus, voice changes, and few episodes of dysphagia. She denied weight loss, night sweats, chest pain, or hemoptysis. ⋯ She had neither asbestos nor occupational exposure. She had no family history of malignancy.
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A 31-year-old man with a medical history of well-controlled asthma presented with a 3-week history of midsternal chest pressure and shortness of breath. His symptoms were associated with malaise, weakness, 40-pound weight loss over several months, and intermittent fever up to 38.3ºC. ⋯ He denied any exacerbating or relieving factors for his symptoms. Additionally, he had a pruritic rash on his thighs for the last year that remained unresolved despite antifungal medication.