CHEST Guidelines-A-51-Year-Old-Man-With-Dyspnea-and-a-Pulmonary-Nod

A-51-Year-Old-Man-With-Dyspnea-and-a-Pulmonary-Nod

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A 51-year-old man presented with a two-year history of chest tightness, exertional dyspnea, and occasional chest pain. An initial CT scan showed a ground glass opacity in the right upper lung lobe, leading to a diagnosis of pulmonary infection and antibiotic treatment. However, his symptoms persisted, and follow-up CT scans showed a solid nodule. After a video-assisted thoracoscopic surgery and a right upper lobectomy, no malignancy was found. Despite worsened symptoms, further evaluations revealed pulmonary artery issues, including embolism and thrombosis, which were initially managed with warfarin.<br /><br />A more thorough workup at a later hospital visit showed negative results for rheumatologic and immunologic problems, but a diagnosis of isolated pulmonary vasculitis was made based on CT and histological findings. This rare condition, distinct from systemic vasculitis, showed pulmonary arterial involvement manifested by thickened arterial walls, fibrosis, and inflammatory infiltrates without systemic features.<br /><br />Treatment involved prednisone and warfarin, resulting in significant improvement. However, recurrence of symptoms led to an increased prednisone dose and additional immunosuppressive therapy (cyclophosphamide). Over three years of follow-up, the patient's condition stabilized with normalized pulmonary artery pressure and no further symptoms.<br /><br />Isolated pulmonary vasculitis is challenging to diagnose due to its rarity and overlap with other conditions like pulmonary hypertension and thromboembolism. Diagnosis typically involves clinical, radiologic, and histological assessments. Timely immunosuppressive treatment can prevent irreversible damage and contribute to a good prognosis. Although initial symptoms were misleading, systematic investigations led to effective disease management.

Keywords

isolated pulmonary vasculitis

chest tightness

exertional dyspnea

pulmonary artery

video-assisted thoracoscopic surgery

prednisone treatment

cyclophosphamide

pulmonary hypertension

thromboembolism

immunosuppressive therapy