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Autopsy and Medicine |

Case of the Month

Eric A. Pfeifer, MD; Johannes Bjornsson, MD; Randy Hanzlick, MD; and the The Autopsy Committee of the College of American Pathologists
Arch Intern Med. 1998;158(1):14. doi:10.1001/archinte.158.1.14.
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A 53-YEAR-OLD white woman was admitted to the hospital with a 3-day history of cough and dyspnea. Two years previously, a ductal carcinoma of the breast (already with widespread metastases) had been diagnosed. On this admission, significant arterial hypoxia was noted. The results of echocardiography showed right ventricular dilatation. An electron beam computed tomographic scan was interpreted as negative for pulmonary embolism. Despite the interpretation, the patient was diagnosed as having pulmonary thromboembolism and was given anticoagulant therapy. She died of progressive respiratory failure 2 weeks after admission to the hospital.

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Upper part of figure shows no gross evidence of pulmonary thromboembolism or metastatic carcinoma in a patient with ductal carcinoma of the breast who died of progressive respiratory failure. Inset at bottom left shows a photomicrograph of a representative small pulmonary arteriole with tumor microemboli, which were present throughout the pulmonary vasculature and resulted in pulmonary hypertension, cor pulmonale, and death (hematoxylin-eosin, original magnification ×200).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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