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Make the Diagnosis: Nose bleeds, hypoxemia, and polycythemia equals?

(MedPage Today) -- Case Study: A 45 year-old woman initially came to medical attention for multiple episodes of epistaxis. Upon further investigation, she was discovered to have polycythemia (Hemoglobin 18.2) and hypoxemia (oxygen saturation of 84% on room air). This chest X-ray was taken after an intervention was performed. What condition does she have?