Case 219


A 35 year-old male presented with coughing, night sweats, dyspnea and heart palpitations in the past 10 months. During the last three months he also complained of weight loss of about 10 kg, hemoptysis, worsening dyspnea and desaturation as well as retrosternal pain during breathing. The chest X-Ray was unremarkable and a computed tomography angiography was inconclusive. A ventilation/perfusion scintigraphy with 99 mTc-Phytate/MAA was obtained.

Image 1: Ventilation/perfusion scintigraphy with 99mTc-Phytate/MAA.

Based on the image and on the clinical picture, which of the following is the most likely diagnosis?

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