Case 4 Cardiology

Progressive dyspnea

Work it one clue at a time. The diagnosis stays hidden until you reveal it.

Clue 1

A middle-aged woman presents with progressive dyspnea. You start with her hands. What do you notice? Does it generate any hypotheses in your mind?

Clue 2

Could these small erythematous lesions be telangiectasias? Let’s see if they blanch and refill by pressing on one of them.

Clue 3

Clue 4

Clue 5

Indeed, they do, confirming your suspicion. What condition comes to mind? Perhaps you are thinking about hereditary hemorrhagic telangiectasia (HHT). Can it cause dyspnea? Yes, via pulmonary AVMs. What other condition can present with telangiectasias that may involve the lungs?

Your new hypothesis leads you to examine the hands further, discovering that the patient has a hard time completely straightening her fingers. You ask her to make the universal sign of prayer.

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