Possible right bronchial obstruction.
The decreased breath sounds and elevated right hemidiaphragm on chest xray suggest a decreased
volume of ventilation to the right lung. This process is not severe enough to
cause cyanosis; there is no evidence of heart failure and signs of chronic cyanosis
(digital clubbing) are not present. Digital clubbing may also occur in association
with some pulmonary tumors, for reasons that are not understood. Note also that the patient's
respiratory rate and heart rate are increased. It is not clear at this point what is driving
the patient's respiration.
At this point, a tumor in one of the right main bronchi with progressive obstruction
of airflow to that lung would be a consideration.
Be aware that decreased airflow to a lung or lobe can also occur when blood flow to
that area of lung is decreased, because of the lung's own autoregulation of ventilation
to match perfusion.