A 51-year-old man with chronic cough and left hilar prominence.

PAS are rare tumours with different histological subtypes, have limited therapeutic options, and overall dismal prognosis if not operable. PAS can be a radiographic mimicker of acute pulmonary embolism and CTEPH, as well as tumour thrombus. Inappropriate thrombolytic and/or anticoagulant therapy can delay diagnosis by 3–12 months. “Atypical” radiographic features of PAS lead to earlier diagnosis and possibly better outcomes. Pre-procedural diagnostics decrease diagnostic uncertainty and define the safest means of biopsy.