Undercover and Overlooked

N Engl J Med 2004;351:1014-9. Copyright © 2004 Massachusetts Medical Society. A 67-year-old overweight man was seen by his physician because of a two-month history of shortness of breath, a nonproductive cough, and bilateral swelling of the lower extremities. He also reported a tight sensation in the neck, occasional wheezing, and an increase in dyspnea after meals. The patient noted the onset of symptoms soon after a hunting trip in November. He had no other constitutional symptoms and had not ingested or had contact with anything unusual during his trip. His history was notable for gastroesophageal reflux and a remote pneumonia. He had no history of lung or heart disease, occupational exposure, allergies, or tobacco use.