Wheezing, hypoxia, and dyspnea in a 62-year-old woman

This patient presented with dyspnea, hypoxia, and generalized wheezing; however, her pulmonary function testing did not suggest asthma. Subsequent evaluations for conditions that may mimic asthma were not helpful. An invasive procedure (pulmonary angiogram) was required to diagnose pulmonary embolism, a potentially life threatening but treatable condition. The angiogram was performed despite nondiagnostic ventilation and perfusion scans because of a high index of suspicion for pulmonary embolism. In our patient, observation revealed episodes of sudden tachycardia, dyspnea, and increased wheezing which further raised our suspicion. Because pulmonary emboli can have such protean manifestations, it would be wise to consider pulmonary emboli in any patient with presumed asthma who has symptoms out of proportion to his or her pulmonary function testing and/or is not responding to treatment.