K. Rauhilla, MD

A 72-year-old woman presented for her annual physical examination. She had been treated for tuberculosis 20 years earlier. The patient did not smoke cigarettes; she denied fever, chills, and rigors.

A 64-year-old woman with a history of diabetes, hypertension, and lymphoma was admitted to the hospital with a dull headache, conjunctival congestion, and slight dyspnea. Her pulse rate was 96 beats per minute; blood pressure, 146/68 mm Hg; and respiration rate, 22 breaths per minute. She also had increased jugular venous distention; cardiovascular and chest examination findings were normal. Edema of both arms and dilated blood vessels on the anterior chest wall were noted.

An 85-year-old man was admitted to the hospital with a cough and shortness of breath of 1 week's duration and a fever and increased sputum production for 2 days. His history included renal cell carcinoma and metastatic renal cancer for 2 years. The patient had smoked cigarettes for 30 years. He had lost 30 lb during the last few months.

An 85-year-old man was admitted to the hospital with acough and shortness of breath of 1 week’s duration anda fever and increased sputum production for 2 days. Hishistory included renal cell carcinoma and metastatic renalcancer for 2 years. The patient had smoked cigarettesfor 30 years. He had lost 30 lb during the last few months.A chest film revealed pneumonia of the right lowerlobe. Metastatic nodules were noted on the scalp; extensivelung, bone, and brain metastases also were found.

A 64-year-old woman with a history of diabetes, hypertension, and lymphoma was admitted to the hospital with a dull headache, conjunctival congestion, and slight dyspnea. Her pulse rate was 96 beats per minute; blood pressure, 146/68 mm Hg; and respiration rate, 22 breaths per minute. She also had increased jugular venous distention; cardiovascular and chest examination findings were normal. Edema of both arms and dilated blood vessels on the anterior chest wall were noted.

A 72-year-old woman presented for her annual physical examination. She had been treated for tuberculosis 20 years earlier. The patient did not smoke cigarettes; she denied fever, chills, and rigors.