September 2024 Pulmonary Case of the Month: An Ounce of Prevention Caused a Pound of Disease

Susanna G. Von Essen MD

University of Nebraska Medical Center

Omaha, NE USA

History of Present Illness

A 55-year-old woman is self-referred for dizziness, fatigue, and difficulty concentrating. She was well until 2 months prior to this visit. She says she feels like she is in a “fog”.  She also complains of a “tight chest”.

PMH, SH, and FH

She has a past medical history of hypertension and presently takes metoprolol. She has had a tubal ligation and a breast lumpectomy in the past. There is a questionable history of a positive Cardiolite nuclear stress test.

She is divorced and lives alone in a small town in Iowa. She does not smoke, drink to excess or used illicit drugs.

She has worked assembling bird houses for 20 years. She attributes her problems to a workplace exposure because she seems worse when opens the large shipping containers with the birdhouse parts. Although she worked 20 years previously without problems, her symptoms began 2 months ago after her company merged with a Chinese company. The wooden pieces are manufactured in China and the pieces are shipped to the US for assembly.

Her family history is unremarkable.

Physical Examination

Her physical examination is unremarkable.

Which of the following are indicated  for further workup?

1. Cardiology referral
2. Neuropsychological testing
3. Pulmonary function testing (PFTs)
4. 1 and 3
5. All of the above

Cite as: Von Essen SG. September 2024 Pulmonary Case of the Month: An Ounce of Prevention Caused a Pound of Disease. Southwest J Pulm Crit Care Sleep. 2024;29(3):23-25. doi: https://doi.org/10.13175/swjpccs034-24 PDF