Level 1: Dyspnea – Contrasting Case #3: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient is a 34-year-old previously healthy man who presents to clinic with a four-month history of progressively worsening exertional dyspnea. During this time he has also noticed easy fatigability. He has occasional palpitations with exercise, but never any chest pain or tightness. He reports no syncope or pre-syncopal episodes. He reports no coughing, wheezing, or hemoptysis. He denies any additional constitutional symptoms. He has never used tobacco, alcohol, or illicit substances. A 12-point review of systems is unremarkable.

PE – The patient appears well nourished, alert, oriented, pleasant and in no apparent distress. Breath sounds are clear to auscultation bilaterally. Cardiac exam shows fixed splitting of S2 and a pulmonary outflow murmur. No rubs, or gallops are present. There is no JVD. Examination of the extremities shows no clubbing. The remainder of the exam is unremarkable.

CXR shows prominent pulmonary vascular markings.