A patient presented for evaluation of dyspnea. Her trouble breathing had been going on for a few days and kept getting worse. No coughing. No fevers. No other symptoms. No medical history. She smoked a couple packs of cigarettes per week.
Her physical exam was entirely normal. Lungs were clear. Heart sounds normal. Labs (including CBC, CMP, d-dimer, and cardiac enzymes) and chest x-ray normal. EKG normal.
Intermittently, her pulse oximeter readings would dip down into the low 80s. Then she’d ring the call bell, stating that she couldn’t catch her breath. When staff went in the room to check on her, the saturations would go back up to the mid to high 90s.
We ordered an ABG on room air which was normal. Then we had her walk up and down the hallway with the pulse oximeter attached. Her saturation stayed above 95% the whole time.
The patient was getting more anxious and showed us multiple pictures of the oximeter on her iPhone with readings as low as 82%. She even began crying when we talked about sending her home with some steroids and a metered dose inhaler. “I’m afraid I’m going to die,” she said.
Anyone have a diagnosis yet?
Lots of good guesses.
Rest of the story and diagnosis posted in the comments section.
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