Forty-year-old man with dyspnoea, haemoptysis and night sweats. Issue 12 (16th February 2019)

• Record Type: Journal Article
• Authors: Brennan, Paul F; King, Oonagh; Spence, Mark S
• Is Part Of: Heart. Volume 105:Issue 12(2019)
• Page Start: 919
• Page End: 925
• Publication Date: 2019-02-16
• Subjects: positron emission tomographic (pet) imaging -- endovascular procedures for aortic and vascular disease -- secondary pulmonary hypertension -- palliative care -- cardiac catheterization and angiography; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2018-314511
• Languages: English
• ISSNs: 1355-6037

Abstract

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? Right upper lobe bronchopneumonia. Submassive pulmonary embolism. Right upper lobe squamous cell carcinoma. Primary pulmonary artery angiosarcoma. Giant cell pulmonary arteritis.