ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 17
Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed
He had
dyspnea on minimal exertion and was being considered for a cardiac
transplant.
He presented to this hospital with a 1 month history of intermittent hemoptysis. A new indistinct mass was noted by his local physician and he underwent bronchoscopy at that hospital. No endobronchial mass was identified but cytology obtained during the bronchoscopy was interpreted as showing atypical cells. However, a definite diagnosis of malignancy could not be made from the specimen. His arterial blood gases on admission were: PH 7.52 PCO2 35 PO2 84. His diffusing capacity was normal.
His chest x-ray demonstrated an enlarged heart and vague density
that could only be seen on the PA radiograph.
A chest CT was ordered to investigate the left lung abnormality.
The lung window demonstrated a homogenous density contiguous with the
major fissure, suggesting a pulmonary infarct.
The
mediastinal images revealed clot in the left main pulmonary artery
and in the tip of the left atrial appendage.
Case Assessment
This is a 52 year old male with severe organic heart disease who
presents with chronic dyspnea, hemoptysis and a mass on the chest
x-ray.
The presentation of pulmonary embolus can simulate many diseases
including a primary lung malignancy.
CT is
often helpful in suggesting the correct diagnosis.
(REFERENCE)
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