A man with dyspnea relieved by head tilting

A 74-year-old man pre-presented with persistent nonexertional dyspnea. He h ad been hospitalized six weeks earlier with a diagnosis of chronic obstruct ive pulmonary disease, for which he was treated with prednisone. He subsequ ently found breathing to be easier when tilting his head backwards. He had lost 35 lb in the last six months, primarily because of a poor appetite, bu t had had a few episodes of minor hemoptysis.