A Diagnostic Conundrum

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A Diagnostic Conundrum Eugene Shostak, MD, Rasheed Ameer, MD, James Gruden, MD, Jose Jessurun, MD CHEST Volume 155, Issue 5, Pages e131-e135 (May 2019) DOI: 10.1016/j.chest.2019.02.318 Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 1 A-B, Posterior-anterior (A) and lateral (B) views of chest radiograph showing lobulated opacity in the right middle lobe (arrow). CHEST 2019 155, e131-e135DOI: (10.1016/j.chest.2019.02.318) Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 2 A-C, Contrast-enhanced chest CT scan showing dilated branch of pulmonary vein (red arrow) entering a lobulated tubular density in the right middle lobe (blue arrow). Small transfissural collaterals are seen entering right lower lobe (yellow arrow). CHEST 2019 155, e131-e135DOI: (10.1016/j.chest.2019.02.318) Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 3 A, Hematoxylin and eosin stain under low magnification showing abnormally dilated varicose veins and areas of hemorrhage intermixed with alveolated lung parenchyma. B, Higher magnification lung parenchyma replaced by engorged vascular spaces. H = hemorrhage; P = alveolated lung parenchyma; S = vascular spaces; V = varicose veins. CHEST 2019 155, e131-e135DOI: (10.1016/j.chest.2019.02.318) Copyright © 2019 American College of Chest Physicians Terms and Conditions