Mr. [**Known patient lastname 4075**] is a 63 yo man with h/o biphenotypic ALL, now Day + 32
   from allogeneic SCT, who presents to clinc with one week of worsening
   SOB and two days of a clear productive cough.  The patient states his
   SOB occured when lying flat, but not with activity.  Also admitted to
   chest pressure which would come and go in his left chest no related to
   the SOB.  Sleeps with 3 pillows (no change from baseline), denies PND;
   admits to a slight increase in lower extremity edema.  Admits to low
   grade fevers to the 99's and crampy abdominal pain.  Denies chills,
   night sweats, vomiting, or diarrhea.
   Assessment and Plan
   Assesment: This is a 63 year-old male with a history of h/o
   biphenotypic ALL, now Day + 32 from allogeneic SCT, who presents with
   hypoxia, one week of worsening SOB, and two days of productive cough.
   Plan:
   # Hypoxia: The patient developed acute onset of hypoxia accompanied by
   fever and a one day cough with sputum production.  Given that the
   patient is about 1 month s/p allogenic SCT the differential is broad
   and would include bacterial pneumonia, viral pneumonia (CMV, flu), and
   opportunistic infections including fungal infections.  Patient also has
   a history of CMV infection, aspergillus and Leggionare's disease and is on
   posaconazole.  His CXR showed an opacification of the left basilar lobe
   and also right upper lobe concerning for pneumonia as well as a small
   loculated right pleural effusion.  Also in the differential is
   noninfectious causes such as PE, CHF, or MI.  US were negative for clot
   and his first set of CE were negative.