The specimen is a slice of left lung, showing both lobes; at the apex of the lower lobe, there is an
infarction extending to the pleura, and measuring some 10 x 5 cm. The infarct shows a
haemorrhagic border, with central necrosis. In the upper lobe, there is an extensive emphysematous
change, with a bulla visible on the pleural surface.
This man had shortness of breath on exertion for many years. In May 1976, he developed
epilepsy. A chest X-ray showed an opacity in the lung; a brain scan and a liver scan showed no
space-occupying lesions. He had been a heavy smoker. He died in June 1976. The lungs showed
extensive centrilobular emphysema and evidence of chronic bronchitis; a massive recent thrombus
was found in the pulmonary arteries, with older organising thrombus in relation to the infarction.
Examination showed no abnormality.