An 88-year-old dyspneic woman: What Is Your Diagnosis?

An 88-year-old woman presented to our clinic with a long-term history of cough, dyspnea, and fatigue. She had no history of smoking or biomass exposure. Her medical history revealed that she was treated with an antibiotic for three months eight years ago, but she did not recall the name of the drug or the indication. The results of routine blood testing and physical examination were unremarkable however, renal function test results were poor. The C-reactive protein level was 23 mg/L. Cardiac enzymes were at normal levels. Chest X-ray revealed a right hilar lobulated mass. Intravenous contrast could not be infused due to high creatinine levels. Non-contrast-enhanced multidetector computed tomography (MDCT) of the chest showed a well-delineated, nodular, hypodense mass with fluid attenuation in the right pulmonary artery (Figure 1) and multiple millimetric, hypodense lesions filling the upper lobe branches and surrounding the parenchyma (Figure 2, 3). The right ventricle volume and main pulmonary artery width were within normal limits. There was no flattening or paradoxical bowing of the interventricular septum. There were no visible lesions in the right atrium. A hypodense lesion with visible septa was shown adjacent to the inferior vena cava at images through the abdomen (Figure 4).