A 39 year-old female presents to the emergency department by ambulance from home with worsening dyspnea and fatigue over the past 3 days. She is 6 days post-partum after an uncomplicated full-term vaginal delivery. This is her first pregnancy, during which she had developed gestational hypertension in the last 6 weeks of her pregnancy and was started on Labetalol 200mg bid. She denies chest pain, cough, fever or calf pain.
On exam you note an obese female in moderate respiratory distress though speaking full sentences. Paramedics reported that her room air oxygen saturation was initially 86%.
Temp. 98.2°F (36.8°C), HR 95, RR 22, BP 148/83,
O2 sat.94% on 2-L nasal cannula.
Upon examination you note an obese female in moderate respiratory distress. Breath sounds are diminished bilaterally with faint expiratory wheezes. You note an unremarkable cardiac exam. The patient also has peripheral edema which she states has persisted after the pregnancy. An ECG reveals a sinus rhythm without signs of ischemia. Urinalysis is negative for protein. Labs are sent and you obtain a chest x-ray.
What is your interpretation of this chest x-ray?
What is this patient’s likely diagnosis?
What is the next diagnostic step?