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A 24-year-old man was referred to the haematologists for investigation of unexplained anaemia on the background of a 6-month history of exertional breathlessness, mild cough and night sweats. Investigations revealed iron-deficiency anaemia (haemoglobin 94 g/L), thrombocytosis and markedly elevated inflammatory markers (C-reactive protein (CRP) 235 mg/L). A CT scan of his chest identified a large expansile filling defect within the left main pulmonary artery, almost entirely occluding the left-sided pulmonary circulation, which had high-grade 18F-fluorodeoxyglucose (FDG) uptake on a subsequent positron emission tomography (PET) CT (figure 1).
The lesion …