Apnea, hypoventilation and pulmonary hypertension Quiz: Ace Your Exams

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A 64-year-old man with a history of hypertension and COPD presents to his primary care PA for evaluation of chest tightness and extremity swelling. The patient reports chest tightness on his daily walk, and he noticed his legs look “puffy.” Physical exam is notable for a loud P2 heart sound, jugular venous distention, and 2+ pitting edema of the lower extremities bilaterally. Laboratory examination reveals normal troponin and B-natriuretic peptide levels. An ECG is demonstrated below. The patient undergoes right heart catheterization, which shows a mean pulmonary arterial  pressure of 34 mm Hg. Which of the following is the most likely observation seen on histologic examination of this patient’s lungs?



Reproduced from: wikipedia

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