Case 303 -- Progressive Shortness of Breath

Contributed by Hina Sheikh, MD, Remigio Gregorio, MD and Samuel Yousem, MD
Published on line in April 2002


This was a 67-year old man who presented to the emergency department with worsening dyspnea and cough for 8 months and new onset chest pain. Past medical history included myocardial infarction 10 years ago, hypertension and a positive PPD test. He had a smoking history of 15 pack-years.

Computed tomography of the chest showed large filling defects in the main pulmonary artery and its major branches and a contiguous cavitary mass in left lower lobe of the lung (Figs. 1 and 2).

The patient was taken for surgery. Intraoperative exploration of the pulmonary vasculature showed tumor mass in the main and left pulmonary arteries extending up to the origin of the right pulmonary artery.


The specimen consisted of a left lung, mediastinal lymph nodes and multiple fragments of pulmonary artery vasculature. The left lung showed a heterogenous 4.5cm hilar mass composed of tan, firm and focally friable areas admixed with softer, translucent, gray areas. This mass was predominantly present in the main pulmonary artery and extended into the lung parenchyma of the upper lobe. A homogenous, firm, tan, subpleural mass was present in the lower lobe. Proximal to the lower lobe mass, the pulmonary vessels showed "mucoid plugging."




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