case_images: PMC11291234_01
case_images: (A) the CT image showed a lobulated and spiculated mass (white arrow) in the apical segment of the left upper lobe. (B) Hematoxylin and eosin stained paraffin sections showed fibrous connective tissue (at x200).
case_images: fcvm-11-1434734-g001.jpg
case_images: PMC11291234_01_fcvm-11-1434734-g001.jpg
case_images: F1
case_images: Chest CT revealed a lobulated and spiculated mass in the apical segment of the left lung upper lobe, measuring approximately 4.8cm x 3.7 cm (Figure 1A). Pathological findings showed predominantly fibrous connective tissue with some alveoli showing organizing pneumonia (Figure 1B).
case_images: (A) Mid-esophageal aortic valve short-axis view of transesophageal echocardiography on admission showed that the left and right coronary valves of the aortic valve were 18.6 x 6.8 mm and 22.0 x 7.6 mm, respectively. (B) Mid-esophageal aortic valve short-axis view of transesophageal echocardiography after treatment showed improved thickening of the left and right coronary valves of the aortic valve, which were 17.1 x 6.1 mm and 20.9 x 7.1 mm, respectively. LCC, left coronary cusp; RCC, right coronary cusp. (C) Apical five chamber views of transthoracic echocardiography showed moderate regurgitation flow signal during diastole of the aortic valve. (D) Color Doppler ultrasound showed accelerated blood flow through the aortic valve during systole.
case_images: fcvm-11-1434734-g002.jpg
case_images: PMC11291234_01_fcvm-11-1434734-g002.jpg
case_images: F2
case_images: Aortic valve opening was limited and closure was poor (Figure 2A). Color Doppler ultrasound showed accelerated blood flow through the aortic valve during systole, with a peak speed of 2.7 m/s, a pressure gradient of 29 mmHg, and moderate regurgitation flow signal during diastole (Figures 2C,D). Echocardiogram showed improvement in the thickening of the left and right coronary cusps of the aortic valve compared to the previous examination (Figure 2B). p-ANCA and anti-MPO antibodies decreased significantly throughout the treatment process.
case_images: PMC11291234_02
case_images: (A) CT showed multiple nodular, striated, and mass-like shadows (white arrow) in the left upper lobe of the lung. (B) Hematoxylin and eosin stained paraffin sections showed interstitial fibrotic tissue proliferation and scattered few chronic inflammatory cell infiltrates (at x200). (C,D) Pulmonary artery CT angiography showed thickening and narrowing (white arrow) of the proximal walls of the left and right pulmonary arteries.
case_images: fcvm-11-1434734-g003.jpg
case_images: PMC11291234_02_fcvm-11-1434734-g003.jpg
case_images: F3
case_images: Chest enhancement CT showed no significant changes in lung lesions compared to six months earlier, and stenosis at the beginning of the left and right pulmonary arterial trunks (Figure 3A). Pulmonary artery CT angiography showed uneven thickness of the main pulmonary artery, thickening and narrowing of the proximal walls of the left and right pulmonary arteries, and occlusion of the branches of the upper left pulmonary artery (Figures 3C,D). Pathological findings showed interstitial fibrotic tissue proliferation and scattered few chronic inflammatory cell infiltrates, which further supported our diagnosis (Figure 3B).
case_images: Parasternal pulmonary artery long axis view of transthoracic echocardiography on admission showed narrowing of the main pulmonary artery lumen with an internal diameter of 15 mm. (B) Parasternal pulmonary artery long axis view of transthoracic echocardiography after treatment showed a slight improvement in the narrowing of the main pulmonary artery, with an internal diameter of 17 mm. (C,D) Color Doppler showed that the systolic blood flow velocity of left and right pulmonary artery was about 3.0 m/s and 3.3 m/s, respectively.
case_images: fcvm-11-1434734-g004.jpg
case_images: PMC11291234_02_fcvm-11-1434734-g004.jpg
case_images: F4
case_images: Echocardiography showed that the wall of the main pulmonary artery and the left and right pulmonary arteries were unevenly thickened, and the lumen was narrowed (Figure 4A). Color Doppler showed a colorful mosaic pattern of blood flow in the main pulmonary artery and the left and right pulmonary arteries during systole, with systolic blood flow speeds of approximately 3.5 m/s, 3.0 m/s, and 3.3 m/s, respectively (Figures 4C,D). Follow-up echocardiogram showed a reduction in stenosis of the main pulmonary artery and the right and left pulmonary arteries (Figure 4B).