title: Isolated shortness of breath in a woman with a history of Hodgkin lymphoma.
abstract: BACKGROUND
  Isolated shortness of breath in the patient with a history of a malignancy creates a diagnostic challenge and serves as a source of anxiety. Although cancer recurrence is typically the first concern of the patient and the clinician, toxicities of anticancer therapies must also be considered.
  
  
  METHODS
  A case of a 49-year-old woman with a distant history of Hodgkin lymphoma with 2 months of progressive dyspnea is presented and discussed.
  
  
  RESULTS
  Although the patient was found to have bilateral pleural and pericardial effusions that were concerning for a recurrence of malignancy, analysis and cytology of fluids were negative for cancer. Instead a diagnosis of effusive-constrictive pericarditis secondary to radiation therapy was made.
  
  
  CONCLUSIONS
  When treating a patient with a history of malignancy who presents with dyspnea, it is important to consider the downstream effects related to cancer treatments, even decades later, to guide specific therapies and to assuage the patient's fears.
authors.affiliation: Post-Graduate Year 2, Internal Medicine Residency Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Katharine R
authors.initials: KR
authors.lastname: Clapham
authors.affiliation: Post-Graduate Year 2, Internal Medicine Residency Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Rupal D
authors.initials: RD
authors.lastname: Bhimani
authors.affiliation: Post-Graduate Year 1, Internal Medicine Residency Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Cooper
authors.affiliation: Chief, Avery D. Weisman Psychiatry Consultation Service, Massachusetts General Hosiptal, Boston, MA, USA Director, Office for Clinical Careers, Massachusetts General Hosiptal, Boston, MA, USA Ned H. Cassem Professor of Psychiatry in the field of Psychosomatic Medicine/Consultation, Harvard Medical School, Boston, MA, USA tstern@partners.org.
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Stern
mesh_terms: D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D006689:Hodgkin Disease / Q000150:complications* / Q000532:radiotherapy; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010490:Pericardial Effusion; D010494:Pericarditis, Constrictive / Q000175:diagnosis* / Q000209:etiology; D010996:Pleural Effusion; D011832:Radiation Injuries
keywords: anxiety; constrictive pericarditis; dyspnea; malignancy; radiation therapy; shortness of breath