Contributed by Shashi Ariyanayagam-Baksh, MBBS
Published on line in December 1998
The patient was a 72 year old white female who presented to the emergency room with a one week history of acute onset respiratory distress that gradually progressed. There was no associated chest pain, cough, productive sputum or fever. The patient was stabilized on 2 L of oxygen via nasal cannula and discharged. She was subsequently readmitted three days later with progressively increasing dyspnea and cyanosis. Additional pertinent history included severe atherosclerotic coronary artery disease, chronic atrial fibrillation, Sheehan's syndrome (panhypopituitarism) and hypothyroidism. Over the ensuing 48 hours the patient showed deterioration of her respiratory status with the development of refractory cardiogenic shock and acute renal failure secondary to acute tubular necrosis. This culminated in the patient's death, approximately nine days after initial symptomatology. An autopsy was authorized which was restricted to the chest and abdomen.