Dx 2

[IMG SURVIVOR]

A 60-year-old man presents to the emergency department complaining of shortness of breath, cough, and copious sputum production. He states that he has been coughing for years, and has had increased sputum production for several months each year. On examination, he is obese, afebrile, cyanotic, and in acute distress. Coarse rales are auscultated bilaterally at the lung bases. He smokes two packs of cigarettes a day and has a seventy-five pack-year smoking history. A chest x-ray film appears normaI, except for slightly enlarged lung fields.



Which of the following is the most likely diagnosis?
/ A. Chronic bronchitis
/ B. Emphysema
/ C. Myocardial infarction
/ D. Pneumonia
/ E. Pulmonary embolus

[IMG SURVIVOR]

The correct answer is A. This patient has findings classic for the "blue bloater" of chronic bronchitis. Patients with chronic bronchitis have excessive tracheobronchial mucus production sufficient to cause cough with expectoration for at least three months of the year for more than two consecutive years. "Blue bloaters" are named for their obese body habitus, copious sputum production, and cyanotic episodes. This condition may occur initially without airway obstruction, but eventually, most patients progress to obstructive disease.