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Download the article PDF: Clinical Image Challenges May 2026
A 26-year-old female presents to urgent care with a persistent productive cough for 1 week. Over the past 3 days, she reports progressive shortness of breath and fatigue. She has a history of recurrent pneumonia. Vital signs show the patient is afebrile with normal blood pressure, heart rate, respiratory rate, and oxygen saturation. Physical examination revealed clear lung sounds with diminished air movement in the bilateral bases. Jugular venous distension (JVD) at 4 cm above the sternal angle and trace bilateral lower extremity edema to the ankles are noted. Cardiac exam reveals rightward displacement of the point of maximal impulse (PMI) and a 2/6 systolic murmur. Chest radiographs were ordered.
View the chest x-ray image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
