A 27-year-old woman was referred to the pulmonary clinic for persistent shortness of breath for 2…

A 27-year-old woman was referred to the pulmonary clinic for
persistent shortness of breath for 2 months, along with a sore throat and a
hoarse voice. The symptoms had begun with a viral syndrome including sore
throat, myalgias, and fever, progressing to cough and chest discomfort. All
symptoms except her shortness of breath and hoarseness had resolved. She
complained of being particularly short of breath while lying down and not being
able to lie down on her left side at all because she felt she could not breathe
in that position. She also described running out of breath in the middle of
sentences and of her voice having a hoarse, “airy” quality. She had been
evaluated previously, including a normal chest radiography and spirometry, and
had been told her dyspnea was due to anxiety. No other diagnosis was made. What
clues in her history might suggest a pulmonary disease, and what additional
testing could help identify it?

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