Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 174: A 65-Year-Old Man with Dyspnea on Exertion
Nov 28, 2025
A fascinating case of a 65-year-old man experiencing shortness of breath during tennis reveals the complexities of pulmonary function tests. The hosts dissect lab results, chest imaging, and echocardiogram findings, leading into a detailed discussion on interpreting spirometry. They explore obstructive defects like COPD, restrictive lung conditions, and the clinical implications of DLCO measurements. Ultimately, emphysema emerges as the diagnosis, illustrating the critical nuances of gas exchange and lung health.
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Tennis Loss Highlights Progressive Dyspnea
- A 65-year-old man with progressive dyspnea lost his ability to beat his son at tennis.
- He has a 50 pack-year smoking history and apical diminished breath sounds suggesting possible emphysema.
Combine Spirometry, Volumes, And DLCO
- Use spirometry, lung volumes, and DLCO together to classify obstructive, restrictive, or gas-exchange defects.
- Interpret PFT patterns in clinical context to guide diagnosis and management.
Obstruction Defined By FEV1/FVC
- The FEV1/FVC ratio <0.7 indicates an obstructive ventilatory defect such as COPD, asthma, or bronchiectasis.
- Emphysema typically shows obstruction plus reduced DLCO due to loss of alveolar-capillary surface area.
