Clinical introduction A 40-year-old man presented with a 1-month history of night sweats, haemoptysis, dyspnoea and weight loss. He had never smoked. Physical examination was unremarkable. He was haemodynamically stable. He was anaemic with a haemoglobin of 10 g/L and his D-dimer was elevated at 1.32 µg/mL.
A 12 lead ECG showed sinus rhythm with no abnormalities. A chest radiograph (CXR) was performed (figure 1A). Transthoracic echocardiography revealed normal right ventricular size and systolic function with a step-up, distally, in pulmonary arterial (PA) velocity from 0.7 m/s to 3.2 m/s.
A CT pulmonary angiogram (CTPA) (figure 1B,C) was subsequently performed. The findings of the CTPA prompted further assessment with a positron emission tomography (PET)-CT (figure 1D).
Question What is the likely diagnosis?
Right upper lobe bronchopneumonia.
Submassive pulmonary embolism.
Right upper lobe squamous cell carcinoma.
Primary pulmonary artery angiosarcoma.
Giant cell pulmonary arteritis.
- positron emission tomographic (pet) imaging
- endovascular procedures for aortic and vascular disease
- secondary pulmonary hypertension
- palliative care
- cardiac catheterization and angiography
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Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement This was an individual case summary representing a rare presentation. There is no additional unpublished data.
Patient consent for publication Not required.