The Journal of Thoracic and Cardiovascular Surgery, Vol 72, 581-584, Copyright © 1976 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Silent, chronic, massive pulmonary thromboembolism masquerading as bronchogenic carcinoma
MR Schoenfield and JM Budinger
A unique case is described of a 64-year-old white woman who had silent
thromboembolic occlusion of the right pulmonary artery. Over the ensuing
months, severe pulmonary hypertension developed, as manifested by marked
dilatation and atherosclerosis of the right and left pulmonary arteries and
severe right ventricular hypertrophy. Nevertheless, she remained fully
ambulatory and felt generally well throughout this time. Eventually,
however, the pulmonary arteries became so dilated that they compressed the
recurrent laryngeal nerve as it looped under the aortic arch, and it was
the resulting hoarseness that first caused the patient to seek medical
attention. A work-up disclosed normal peripheral lung fields on x-ray study
and a large dense right hilar mass. Accordingly, the patient was subjected
to an exploratory thoracotomy on the reasonable but mistaken diagnosis of
bronchogenic carcinoma. After the following operation, her condition
deteriorated. She developed bronchopneumonia which, when superimposed on
her already precariously reduced cardiopulmonary function, precipitated
respiratory insufficiency. An independent stroke was the immediate cause of
death.
