An unusual cause of dyspnoea in an 83-year-old woman

An 83-year-old woman was referred for assessment of rapidlyworsening dyspnoea, limiting mobility to 10 yards. She had ahistory of multiple potential sources of her dyspnoea: coronaryartery disease (previous stenting of the right coronary artery,a chronic total occlusion of the mid left anterior descendingartery, and 50% stenosis in the circumflex with normal leftventricular function), chronic obstructive airways disease requiringinhaled bronchodilators and steroids, and