A 72 year-old man presented to AED because of SOB for one week.
He was a chronic smoker 15 pack-years of smoking. After ischemic CVA in 2007, he was cared at old age home though he could manage to walk with stick. He was diagnosed to have goitre in 2008, but he declined any further investigation. He started to have SOB at around one week ago, associated with dry cough. There was no hemoptysis, no wheezy breath, no chest pain or ankle swelling. There was no travel/ occupation/ contact/ clustering (TOCC) history. Temperature at AED was 37.5 C degree, pulse was 110 per minute, and breathing rate was 24 per minute. The SaO2 was 79% with room air, and then 95% with 100% O2 mask. Examination was grossly unremarkable, except the finding of severe dehydration and generalized wasting. The AED officer consulted ICU for ARDS, ?due to severe pneumonia.
The CXR is shown below:
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What are the alarming features? What must be considered apart from severe community-acquired pneumonia?
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