Forty-year-old man with dyspnoea, haemoptysis and night sweats.

Abstract

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.heartjnl;105/12/919/F1F1F1Figure 1Case image panelA 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). 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.