Pulmonary artery fibrous bands - Report of a case with extensive lung infarction and superinfection with Coccidioides immitis, Pseudomonas, and acid-fast bacilli

A 46-year-old woman presented with shortness of breath and frequent lower r espiratory tract infections. A ventilation-perfusion scan showed markedly r educed perfusion of the right lung, and pulmonary arteriogram showed stenos is of the right pulmonary artery. A right pneumonectomy revealed dense whit e fibrous bands partially occluding the pulmonary artery branches and two l arge abscess cavities filled with pus in the upper and lower lobes. Microsc opic examination revealed extensive necrosis of lung parenchyma, suppurativ e granulomatous inflammation with Coccidioides immitis organisms and rare a cid-fast bacilli. Pulmonary artery fibrous bands were originally believed t o be congenital; however, they are now known to be sequelae of thromboembol ic phenomena.