A 76-year-old man who was under treatment for COPD with non-invasive ventilation was sent to the emergency room because of acute dyspnea, with the suspected diagnosis of an acute COPD exacerbation. On auscultation, there were diminished breathing sounds on the right side of the chest. A chest x-ray showed tension pneumothorax, which was treated immediately with chest tube. Computerized tomography of the chest two days later showed interstitial changes of the lung parenchyma, with multiple masses (Figure).
On further questioning, history of pulmonary silicosis was disclosed. Imaging studies revealed multiple brain metastases and an adrenal mass; lung cancer due to silicosis was suspected. The patient died of pneumonia with septic multiple organ system failure.
Even in patients with known pre-existing COPD, dyspnea has broad differential diagnosis. Patients complaining of dyspnea must be examined for serious conditions, and in particular for pneumothorax, which requires immediate intervention and may be worsened by non-invasive ventilation.
Dr. med. P eter Korsten, Clinic for Nephrology and Rheumatology, University Medical Center Göttingen, email@example.com
Prof. Dr. med. Sabi ne Blaschke, Interdisciplinary Emergency Department, Göttingen University Medical Center, Göttingen
Conflict of interest statement The authors declare that no conflict of interest exists.
Cite this as: Korsten P, Blaschke S: A 76-Year-Old Man with COPD and Acute Dyspnea.Dtsch Arztebl Int 2016; 113: 824.DOI: 10.3238 / arztebl.2016.0824
Translated from the original German by Ethan Taub, M.D.