CHEST Guidelines-A-37-Year-Old-Man-With-Interstitial-Lung-Disease&#

A-37-Year-Old-Man-With-Interstitial-Lung-Disease&#

Pdf Summary

This case study outlines the complex medical history and management of a 37-year-old African American male with interstitial lung disease (ILD), progressive dyspnea, and heart failure. The patient presented to the emergency department with worsening shortness of breath over two weeks and associated symptoms including bilateral pitting pedal edema. Previously diagnosed with pneumonia superimposed on ILD, the patient deferred further outpatient evaluation.<br /><br />Upon admission, diagnostic workup revealed low peripheral oxygen saturation, elevated heart rate, and increased cardiac biomarkers. A CT pulmonary angiogram suggested extensive bilateral lung changes without pulmonary embolism. Bedside echocardiography identified a moderate posterior pericardial effusion and a "D-Sign," indicating right ventricular volume overload. Further evaluation ruled out immediate pericardiocentesis despite the presence of a non-collapsible inferior vena cava, as patient stabilization was observed.<br /><br />Subsequent laboratory tests suggested an overlap syndrome of myositis and scleroderma, confirmed by serological markers, including U3 RNP antibodies. Treatment with prednisone was initiated, which led to near-complete resolution of the pericardial effusion after two weeks as visualized by follow-up echocardiography.<br /><br />Point-of-care ultrasound (POCUS) was instrumental in this case for diagnosing and monitoring the patient’s condition, illustrating its effectiveness and cost-efficiency in managing complex dyspnea cases with overlapping cardiac and pulmonary issues. The article emphasizes the utility of bedside echocardiography for real-time management, especially when serial imaging is necessary, and highlights the potential for non-cardiologist clinicians to use POCUS to significantly advance patient care in complex systemic conditions such as those involving scleroderma.

Keywords

interstitial lung disease

heart failure

dyspnea

pericardial effusion

scleroderma

myositis

POCUS

echocardiography

U3 RNP antibodies

African American male