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Man with progressive dyspnoea
  1. En-Jui Liu1,2,
  2. Yen-Yu Liu3,4,
  3. Yu-Hui Chiu2,5
  1. 1 Emergency Medicine, Taitung MacKay Memorial Hospital, Taitung, Taiwan
  2. 2 Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
  3. 3 Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan
  4. 4 Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
  5. 5 Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Dr Yu-Hui Chiu, Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan; yuhui.5848{at}

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Clinical introduction

A 74-year-old man presented to the ED with progressively worsening dyspnoea for 10 days. The patient was diagnosed with small cell lung carcinoma (stage IVb) 2 months prior to presentation but declined intervention. He experienced intermittent barking cough, hoarseness and haemoptysis without fever, and later developed dyspnoea. Physical examination revealed mild expiratory stridor, and laryngoscopy showed right vocal cord palsy without upper airway obstruction. Laboratory test results were unremarkable except for anaemia. Chest radiography was performed (figure 1).

Figure 1

Anteroposterior chest radiograph.


What is the most likely diagnosis?

  1. Pneumonia

  2. Central airway obstruction

  3. Pulmonary embolism

  4. Goodpasture …

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  • Contributors E-JL reviewed the case and drafted the manuscript. Y-YL contributed to manuscript review. Y-HC edited the article and provided final approval for the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement statement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.