Differential Diagnosis for Pulmonary Hypertension
The patient's history of progressive shortness of breath, fatigue, and a diagnosis of pulmonary hypertension two years prior to her death provides crucial context for determining the most likely findings at autopsy.
Single most likely diagnosis:
- E. Plexiform lesions of pulmonary arterioles: This is the most characteristic histopathological feature of advanced pulmonary arterial hypertension (PAH), which is a disease that leads to remodeling and narrowing of the small pulmonary arteries, resulting in increased resistance to blood flow and, consequently, elevated pulmonary artery pressures. The presence of plexiform lesions is a hallmark of severe PAH and would explain the patient's symptoms and diagnosis.
Other Likely diagnoses:
- A. Bronchiectasis: While not directly related to pulmonary hypertension, bronchiectasis can be a cause of secondary pulmonary hypertension due to chronic hypoxia. However, it's less directly linked to the primary diagnosis of pulmonary hypertension compared to plexiform lesions.
- D. Intra-alveolar accumulations of neutrophils: This could be indicative of an acute or chronic inflammatory process affecting the lungs, which might contribute to or exacerbate pulmonary hypertension, but it's not as specific or directly related to the diagnosis as plexiform lesions.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- C. Granulomatous inflammation: This could suggest diseases like sarcoidosis, which can cause pulmonary hypertension among other systemic manifestations. While less common, missing a diagnosis of sarcoidosis could have significant implications for understanding the patient's condition and potentially for family screening or other related conditions.
Rare diagnoses:
- B. Eosinophil infiltrates of bronchi: This might suggest eosinophilic pneumonia or another condition with eosinophilic involvement, which is less commonly associated directly with pulmonary hypertension but could be part of a broader differential diagnosis in patients with unexplained respiratory symptoms.