A patient presents with sudden shortness of breath, crackles, hypertension, and jugular distension. What should you suspect?

The presentation of sudden shortness of breath, crackles, hypertension, and jugular distension strongly indicates acute pulmonary edema. In this condition, fluid accumulates in the alveoli of the lungs, leading to impaired gas exchange and the characteristic crackling sounds heard during auscultation.

The rapid onset of shortness of breath is typical, particularly in cases related to heart failure, which often leads to pulmonary congestion. Jugular distension is indicative of increased central venous pressure, which is commonly associated with right-sided heart failure or fluid overload, both of which can contribute to acute pulmonary edema. Hypertension may also occur as a compensatory response.

In contrast, chronic bronchitis would present differently, usually with a more gradual onset of symptoms and a productive cough due to mucus production. Pneumonia would often be associated with fever and other respiratory symptoms specific to infection, while pneumothorax would typically cause sudden and severe unilateral chest pain along with dyspnea, without the associated jugular distension or crackles indicative of fluid in the lungs.