July 26th, 2020
A 71-year-old man comes to the physician with swelling of both legs and a 9-kg (20-lb) weight gain for the past 6 months. He has had intermittent wheezing and a chronic cough for several years. He uses an over-the-counter inhaler as needed. He has smoked one-half pack of cigarettes daily for 50 years. His blood pressure is 130/80 mmHg. There is jugular venous distention.He has a barrel-shaped chest. There is dullness to percussion and decreased breath sounds over both lung bases. Diffuse crackles and wheezes are heard. The abdomen is distended, with shifting dullness. There is pitting edema to the thighs. Which of the following is the most likely diagnosis?