A 61-year-old female patient with right-sided pleuritic chest pain and fatigue

Abstract

A 61-yr-old Caucasian female patient was investigated because of right-sided pleuritic chest pain. The patient had a 2-month history of chronic, nonproductive cough, extreme fatigue, night sweats and reduced exercise tolerance. Initially, the patient was treated with antibiotics for presumed pneumonia. She had smoked for >20 pack-yrs and her medical history included parotidectomy for Warthin tumour, resection of a benign cyst in the left breast and varicectomy. Physical examination showed no clinical signs of respiratory distress. Sinus rhythm was present with a heart rate of 88 bpm and blood pressure of 135/80 mmHg. Cardiopulmonary auscultation revealed no significant abnormalities and there was no hepatomegaly or limb oedema. No lymphadenopathy was found in the neck, supraclavicular, axillary or inguinal regions. The laboratory results showed an elevated C-reactive protein of 5.02 mg·dL−1. Low haemoglobin and haematocrit values were in keeping with anaemia. Studies of coagulability were all within normal ranges. Arterial blood gas analysis while breathing ambient air showed an arterial oxygen tension of 66 mm Hg, carbon dioxide arterial tension of 40 mmHg, pH of 7.43 and arterial oxygen saturation of 94%. Pulmonary function tests revealed a mild restrictive defect with a reduced diffusing capacity. A chest radiograph (fig. 1⇓) and computed tomography (CT) scans (figs 2⇓ and 3⇓) were performed and the patient underwent bronchoscopy and mediastinoscopy. Bronchoscopy revealed no endobronchial involvement. Subsequent biopsies were all found to be negative. Fig. 1— Chest radiograph. Fig. 2— Axial contrast-enhanced chest computed tomography scan. Extensive soft tissue mass in the right pulmonary artery, extending in different side branches, is indicated by the arrows. Fig. 3— Axial contrast-enhanced chest computed tomography scan. a) Mediastinal window and b) lung window. Two peripherally located wedge-shaped focal consolidations areas at the right lung base are indicated by the arrows. All accessible lymph nodes in the superior mediastinum and the region of the right mainstem bronchus …