Chronic thromboembolic pulmonary hypertension with pulmonary infarction occuring in a hypertensive

We present a 72-year-old man and a known hypertensive with poor drug compliance seen here on 22-03-06, with a 4-year history of progressive dyspnoea, associated with cough and a wheeze. On examination he was chronically ill looking with altered state of consciousness, pale, centrally cyanosed, febrile (T-38 degrees C), in respiratory distress (RR-33 pm). Significant chest radiological findings include marked aortic unfolding and cardiomegaly, with biventricular involvement. Numerous nodular opacities in both lung fields especially the Right side with right apical opacification/thickening. Treatment as appropriate was instituted but unfortunately the patient succumbed after thirty days on admission and an autopsy carried out revealed multiple pulmonary infarcts with pulmonary thrombo-embolism.