Acute Shortness of Breath in an Adult

A 44-year-old male presents with shortness of breath, non-productive cough, and chest tightness to the ski clinic in Winter Park, Colorado. He flew from his home town, San Antonio, Texas, three days earlier. Symptoms began the day after arrival and progressively worsened over the course of the last 2 days. Shortness of breath is exacerbated by physical activity and relieved by rest. He tried his son’s albuterol inhaler with no improvement in his symptoms. He denied fevers, chills, and sick contacts. He is in excellent shape and has never experienced these symptoms before despite many similar ski trips. His past medical, family, and social histories are unremarkable, and he takes no medications. On arrival he appears generally healthy, but exhibits significantly labored breathing. He is afebrile and normotensive, but tachycardic (104 BPM) and hypoxic with an oxygen saturation of 61% on room air. His lung examination is significant for diffuse rales. Chest radiography was performed (Figure 1).