Case 4-2021: A 70-Year-Old Woman with Dyspnea on Exertion and Abnormal Findings on Chest Imaging

A 70-year-old woman was evaluated at the pulmonary clinic of this hospital because of increasing dyspnea on exertion and abnormal findings on chest imaging.In childhood, the patient had eczema, recurrent episodes of bronchitis with a cough productive of mucus, and allergic rhinitis; these conditions abated in adulthood. Twenty years before this evaluation, she had community-acquired pneumonia. Fifteen years before this evaluation, she had an inhalation exposure to aerosolized brick and mortar at a construction site near her home; she subsequently had bronchitis that was treated with a course of nebulizers and inhaled glucocorticoids.Twelve years before this evaluation, the patient began to have episodes of coryza, nasal congestion, itchy and watery eyes, and wheezing, especially in the spring or with exposure to cats, dogs, or dust. She was seen by an allergist. Skinprick testing elicited a response to dust mites, and intradermal testing elicited a response to tree mix and dog dander. Results of pulmonary-function tests are shown in Table . Presumptive diagnoses of asthma and seasonal and environmental allergies were made. She received prescriptions for fexofenadine, mometasone, and inhaled albuterol, to be taken as needed.Eleven years before this evaluation, computed tomography (CT) of the abdomen incidentally revealed mild mosaic attenuation -a patchy ground-glass pattern -at the lung bases. Ten years before this evaluation, the patient was seen by her primary care physician because of several weeks of nonproductive cough, nasal congestion, and intermittent wheezing; she received prescriptions for oral loratadine and inhaled pirbuterol, to be taken as needed. Eight years before this evaluation, she was referred to an allergist. She was considered to have a cough in response