A 70-year-old man gave a history of shortness of breath, which had become worse in the week before admission. He had had cyanosis for three weeks. He had been treated for active pulmonary tuberculosis with chemotherapy in 1969.His blood pressure was 130/100 mm Hg; respirations, 44/min. He had venous distension of the neck but no murmurs or gallop rhythm. There were rales at both bases with diminished breath sounds at the right base. His extremities were cyanotic and cool.The admission posteroanterior and lateral teleroentgenograms are shown in Fig 1 and 2.
Figure 1 shows what seems to be a lobulated elevation of the right hemidiaphragm. It extends to the level of the eighth posterior rib. There is slight blunting of the right costophrenic sulcus. Residual tuberculosis is seen in the right upper lobe. The heart is enlarged. Figure 2 shows blunting of the