A 53-Year-Old Man Comes to the Office with Progressive Exertional

A 53-year-old man comes to the office with progressive exertional dyspnea.  He has smoked 2 packs of cigarettes per day for the last 35 years.  Physical examination shows increased anteroposterior diameter of his chest.  Auscultation reveals decreased breath sounds and scattered wheezes throughout his lungs.  Examination of his extremities is unremarkable.  Echocardiography reveals moderate dilation of the right ventricle and increased central venous pressure.  The absence of peripheral edema in this patient is best explained by which of the following compensatory mechanisms?

A) Decreased capillary permeability
B) Decreased circulating aldosterone levels
C) Decreased interstitial fluid pressure
D) Increased plasma oncotic pressure
E) Increased tissue lymphatic drainage

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