Patient History

This 35 year-old Puerto Rican female presented to the emergency department with a right pneumothorax. There were unilateral right-sided opacities with the right upper lobe pneumothorax on chest radiograph. Past medical history included chronic cough with more recent right pleuritic chest pain. After chest tube placement, there was resolution of the pneumothorax. Subsequent chest x-rays revealed worsening of the lung opacities and clinically, the patient began experiencing hemoptysis and fever. Sputum collection for culture and sensitivity was unsuccessful but broad spectrum antibiotic therapy was empirically started. Blood cultures for aerobic and anaerobic bacteria were negative but there was no clinical improvement. A pulmonary arteriogram was performed as the patient was experiencing increasing dyspnea. This study demonstrated stenosis of the right main pulmonary artery but no pulmonary emboli were identified. A transbronchial biopsy revealed only necrotic tissue. The patient’s clinical condition continued to rapidly decline and a right thoracotomy with pneumonectomy for severe right pulmonary infarction was performed.