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Forty-year-old man with dyspnoea, haemoptysis and night sweats
  1. Paul F Brennan1,
  2. Oonagh King2,
  3. Mark S Spence1
  1. 1 Department of Cardiology, Royal Victoria Hospital, Belfast, UK
  2. 2 Department of Pathology, Royal Victoria Hospital, Belfast, UK
  1. Correspondence to Dr Paul F Brennan, Department of Cardiology, Royal Victoria Hospital, Belfast BT12 6BA, UK; pbrennan07{at}qub.ac.uk

Abstract

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? 

  1. Right upper lobe bronchopneumonia.

  2. Submassive pulmonary embolism.

  3. Right upper lobe squamous cell carcinoma.

  4. Primary pulmonary artery angiosarcoma.

  5. 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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Footnotes

  • 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 There is no additional unpublished data.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.

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