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Older man with acute dyspnoea
  1. Hsuan-An Chen1,
  2. Bao-Luen Chang2,3,
  3. Chih-Jung Chang1,4
  1. 1 Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
  2. 2 Department of Neurology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
  3. 3 College of Medicine, Chang Gung University, Taoyuan City, Taiwan
  4. 4 Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
  1. Correspondence to Dr Chih-Jung Chang, Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; chihjung0729{at}

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Clinical introduction

A 76-year-old man presented to the ED following a fall. He was unconscious initially and complained of dizziness on arrival. There was no recent history of trauma, chest or back pain, headache, fever prior to the episode. His vital signs were: BP, 98/42 mm Hg; RR, 20 breaths/min; and an oxygen saturation level of 97% while breathing ambient air. Physical examination revealed mild laboured breathing, bilateral lung rales and diastolic heart murmur at left sternal border. No oedema was apparent in the extremities. Brain CT, electrocardiography and laboratory studies were unremarkable. Chest radiography was obtained (figure 1).

Figure 1

Chest radiography indicating the possible diagnosis.


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  • H-AC and B-LC contributed equally.

  • Contributors H-AC acquired the clinical data, drafted the manuscript and maintained contact and consent with the patient. B-LC did revision of the manuscript and served as a scientific advisor. C-JC was responsible for editing the article and finally approved 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.