Southwest Journal of Pulmonary, Critical Care and Sleep

University of Nebraska Medical Center

Omaha, NE USA

History of Present Illness

A 71-year-old woman was seen in the emergency department with acute onset of shortness of breath. The patient was well until 3 days prior to admission when she developed pain and swelling in her right calf and ankle. She self-treated with ibuprofen and elevation. She was improving until the afternoon of admission she developed fatigue, dyspnea on exertion, and shortness of breath and came to the emergency department.

Past Medical History

Partial adrenal insufficiency after resection of pituitary tumor in 1992
Growth hormone deficiency, treated with augmentation therapy
Hypothyroidism due to history of pituitary tumor and Hashimoto’s thyroiditis
Gastroesophageal reflux disease
Prediabetic
Hypertension
Iron deficiency, treated with daily iron
Colon polyps (adenomas)
Gluteal tendinopathy, right hip
COVID-19 a month prior to admission with minimal symptoms

Surgical History

Appendectomy at age 16
Resection of pituitary macroadenoma at age 38
Operations for herniated lumbar disks at age 47, 49 and 52
Resection of right tonsil for chronic infection at age 54

Family History

There is a positive family history of deep venous thrombosis in the patient’s mother.

Social History

She is a physician.
She does not smoke or drink alcohol.

Physical Examination

Vital Signs: Normotensive with a regular tachycardia of 106 beats/min. Respiratory rate 22 breaths/minute. SpO2 92% on room air.
Lungs: Clear
CVS: regular rhythm without murmur
Abdomen: soft without organomegaly masses or tenderness.
Extremities: Tender right calf with edema

What should be done next? (Click on the correct answer to be directed to the second of six pages)

Cite as: VonEssen SG. April 2025 Critical Care Case of the Month: Being Decisive During a Difficult Treatment Dilemma. Southwest J Pulm Crit Care Sleep. 2025;30(4):37-39. doi: https://doi.org/10.13175/swjpccs007-25 PDF