A 46 year old man has a two year history of hypertension and pulmonary embolism. He presented to the hospital with chest pain and dyspnea. Imaging showed an obstruction of the pulmonary artery. Two attempts at biopsying the obstruction were unsuccessful and the patient's condition worsened, requiring intubation and finally support was withdrawn. An autopsy was performed. The proximal pulmonary artery was thickened to 3cm with a shaggy and irregular luminal surface.

Thank you to Dr. Matthew Tilson for sharing this case.