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An old-age farmer with chronic dyspnea

      A 94-year-old man, known case of chronic lymphocytic leukemia and chronic lung disease, presented to the Emergency Department with aggravation of his chronic dyspnea and non-productive cough since about 2 weeks prior to hospitalization. He had no complaint of fever or chest pain. At the time of hospital admission, the patient was tachypneic (respiratory rate of 22 breaths/minute), tachycardic (pulse rate of 110 beats/minute), normotensive, and afebrile. His-physical examination was also significant for a decreased breath sound in lower part of right lung field – with a dull percussion -, fine bibasilar crackles, mild and diffuse wheeze, and bilateral lower extremities pitting edema up to the level of calves. The patient's room air pulse oxygen saturation was 86%. Plain chest radiography was taken (Fig. 1; Panel A). Next, he underwent computed tomographic (CT) scan of the lungs (Fig. 1; Panels B and C).
      Fig 1
      Fig. 1Panel (A): Plain radiography of the chest showing abnormal calcification of hilar lymph nodes (black arrowheads) and blunted right costophrenic angle (black asterisk). Panels B and C: CT scan of the chest showing lymph nodes with “egg-shell” calcification (white arrows), and pleural effusion (white asterisk).

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