IMAGES IN THORAX
Metastatic trophoblastic disease masquerading as pulmonary embolism
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A 51-year-old woman presented with a 2-week history of dyspnoea, dry cough and fever which did not improve with a course of oral antibiotics. Her past medical history was significant for a termination of pregnancy more than 5 years previously and a total hysterectomy and bilateral salpingo-oophorectomy shortly thereafter for infarcted fibroids. Physical examination revealed decreased breath sounds over the left lower chest. The chest radiograph showed infiltrates in the left lower zone associated with a small pleural effusion. A CT scan of the thorax (fig 1A) revealed an intraluminal filling defect in the distal left pulmonary artery consistent with a diagnosis of pulmonary embolism for which anticoagulation was promptly started. Lower limb duplex ultrasound was negative for deep venous thrombosis and a CT scan of the abdomen and pelvis did not demonstrate any intra-abdominal or intrapelvic masses. Despite adequate anticoagulation over a 3-month period, the patient failed
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