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A 51-year-old woman who was a smoker presented to our emergency department with acute respiratory distress. Two months previously she had developed dyspnoea aggravated by exertion and a dry cough. Orthopnoea, leg oedema and resting dyspnoea had deteriorated 3 days prior to this presentation. There was no chest pain, fever, anorexia, abdominal pain or body weight loss. On examination she was obese and normotensive. A non-rebreathing oxygen mask was necessary to maintain her oxygen saturation (Spo2) at >90%. She had diffuse lung crackles, elevated jugular veins and pretibial pitting oedema. There was no heart murmur or gallop sounds. The ECG showed sinus tachycardia of 115 bpm. Routine blood tests showed no remarkable findings except D-dimer of 2019 ng/mL. The serum procalcitonin level was …