Case of the month
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An 86 year old AA woman was referred to University Hospital from the dialysis center where she had complained of worsening dyspnea over the past 2 weeks. She denied cough, fever, chills or rigors. Per her dialysis notes, bi-basilar crackles had been noted in recent weeks and an effort to increase dialysis volume was made; however, this led to episodes of hypotension (confirmed by dialysis records). At the time of admission, the patient also complained of bilateral chest pain which was constantly present but increased with deep inspiration. She also reported intermittent swelling of the right arm and right face over the past 8 weeks which became worse after lying down.