Volume 137, Issue 5, Pages 1225-1230 (May 2010) A 50-Year-Old Woman With a History of Atrial Fibrillation Presents With Acute Dyspnea and Pleuritic Chest Pain  Tadhg G. Gleeson, MD, Ian Cheyne, MD, John C. English, MD, Syed M. Quadri, MD, Jonathan A. Leipsic, MD  CHEST  Volume 137, Issue 5, Pages 1225-1230 (May 2010) DOI: 10.1378/chest.09-1362 Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 1 Anteroposterior chest radiograph showing dual-chamber pacemaker in situ and peripheral consolidation with increased heterogeneous opacities in the left upper and lower zones. CHEST 2010 137, 1225-1230DOI: (10.1378/chest.09-1362) Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 2 Axial high-resolution CT scan of the left upper lobe. Ground-glass opacities with thickened interlobular septae (short arrow) and more confluent airspace consolidation in the apical posterior segment (long arrow) (A). Section of the left upper lobe corresponding to axial CT image. Interconnecting pale tan and red linear abnormalities corresponding to secondary lobular septae and paraseptal parenchyma (white arrows) enclose regions of relatively normal lung parenchyma. Bar = 1.0 cm (B). CHEST 2010 137, 1225-1230DOI: (10.1378/chest.09-1362) Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 3 Photomicrograph depicting secondary lobular septum (arrowheads) and adjacent infarcted parenchyma (arrows) that is beginning to organize. The centrilobular region shows mild interstitial thickening but is histologically viable (hematoxylin-eosin, original magnification ×20) (A). Photomicrograph depicting a secondary lobular septum (arrowhead) with intense capillary congestion, organizing airspace exudate, and early infarction involving the paraseptal parenchyma (arrow). A respiratory bronchiole and accompanying pulmonary artery are noted (asterisk) (hematoxylin and eosin, original magnification ×12.5) (B). Photomicrograph illustrating a PA with severe intimal proliferation (arrow) (hematoxylin and eosin, original magnification ×100) (C). B = bronchiole; PA = centrilobular pulmonary artery; V = pulmonary vein. CHEST 2010 137, 1225-1230DOI: (10.1378/chest.09-1362) Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 4 Coronal multiplanar reformat of the chest on soft-tissue windows showing increased soft-tissue density at the left hilum with marked stenosis at the ostium of the left upper lobe pulmonary vein (arrow) (A). Axial image from the same study showing absence of normal enhancement of the left upper pulmonary vein (arrow) (B). Axial image from the same study showing absence of normal enhancement of the left lower pulmonary vein (arrow) (C). CHEST 2010 137, 1225-1230DOI: (10.1378/chest.09-1362) Copyright © 2010 The American College of Chest Physicians Terms and Conditions