P1450 Pulmonary artery sarcoma mimicking as pulmonary thromboembolism for a young man: the role of multimodality imaging for diagnosis

Abstract Patient presentation A 33-year-old man was referred to our hospital suffering fever with shivers, dyspnea, dry cough, and weakness. Initial work up Symptoms appeared three weeks until hospitalization. Laboratory results showed leukocytosis and high levels of inflammatory markers. Haematological diseases were excluded, a chest x-ray showed infiltration in the lower lobe of the right lung, antibiotics were prescribed. Diagnosis and management When clinical and laboratory results showed no signs of improvement, chest computed tomography (CT) scan was performed and bilateral pulmonary artery thromboembolism with right lung infarct-pneumonia was diagnosed (Figure 1, 2). Treatment was supplemented with intravenous anticoagulants. In the course of treatment patient’s status worsened, respiratory failure progressed, so CT scan was performed again and showed massive pulmonary artery thromboembolism without the effect of treatment. Transthoracic 2D echocardiography showed dilated right heart chambers, relative severe tricuspid valve regurgitation, increased systolic pulmonary artery pressure (Video 1, figure 3), pulmonary artery valve masses in the stem which caused obstruction with maximum gradient about 50 mmHg(Video 2, figure 4). For a detailed workup, magnetic resonance imaging (MRI) was done, that revealed tumorous masses from pulmonary artery valve to the pulmonary trunk and right pulmonary branch (Figure 5, 6, 7). The patient underwent pulmoangiography and biopsy was taken out of the masses that suspected sarcoma. The multidisciplinary team came to a conclusion to perform surgery considering worsening patient’s status. The patient underwent pulmonary artery prosthesis implantation and right pneumonectomy (Figure 8). Masses from pulmonary artery valve were examined by pathologists, surgical specimen results showed high grade poorly differentiated pulmonary artery intimal sarcoma (Figure 9, 10). Follow up Early postoperative period was complicated with cardiogenic shock and respiratory failure. Despite extracorporeal membrane oxygenation (ECMO) and high doses of vasopressors patient did not survive the 2nd postoperative day. Conclusions Pulmonary artery sarcoma (PAS) frequently can be misdiagnosed as thromboembolism. Multimodality imaging should be considered pulmonary artery filling defects persist despite proper anticoagulation therapy for early diagnosis and better survival. Abstract P1450 Figure 3.

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Rasmussen's Aneurysm Associate With Pulmonary Artery Vascular Malformation Presented With Haemoptysis

KYAMC Journal ◽

10.3329/kyamcj.v10i3.44424 ◽

2019 ◽

Vol 10 (3) ◽

pp. 168-170

Author(s):

Khaleda Parvin Rekha ◽

Umme Iffat Siddiqua ◽

Md Mofazzal Sharif ◽

Md Musharraf Husain ◽

Mohammad Abdus Salam

Keyword(s):

Pulmonary Artery ◽

Ct Scan ◽

Vascular Malformation ◽

Left Lung ◽

Lower Lobe ◽

Low Grade ◽

Imaging Department ◽

Increased Risk ◽

Risk Of Rupture ◽

Contrast Ct

Rasmussen's aneurysm is an inflammatory pseudo-aneurysmal dilatation of a branch of pulmonary artery associated with a cavitary lung lesion. Like any aneurysm, a Rasmussen's aneurysm is at increased risk of rupture and bleeding into the lungs. A 52 years old male presented with low-grade fever and haemoptysis, chest x-ray revealed a well margined nodular shadow with calcifications in mid zone of left lung associated with ipsilateral upper zone fibrosis and bronchiectasis. The patient had past history of pulmonary tuberculosis eight years back. For characterization of left pulmonary nodule the patient was referred to radiology and Imaging department and contrast CT scan of chest was done. Contrast CT scan of chest with reformat MIP pulmonary angiogram revealed a small pulmonary artery vascular malformation in lateral basal segment of lower lobe of left lung associated with left upper lobar cavitating lesion with fibrosis, traction bronchiectasis and Rasmussen's aneurysm arising from upper lobar apical segmental pulmonary artery. Early surgical or angiographic interventions with endovascular embolization are recommended once it be clearly diagnosed. KYAMC Journal Vol. 10, No.-3, October 2019, Page 168-170

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Pulmonary Artery Sarcoma - Multimodality Imaging

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.192841 ◽

2016 ◽

Vol 6 ◽

pp. 45 ◽

Cited By ~ 1

Author(s):

Nari Jeong ◽

Sang-Hoon Seol ◽

Il Hwan Kim ◽

Ji Yeon Kim

Keyword(s):

Pulmonary Artery ◽

Pulmonary Thromboembolism ◽

Multimodality Imaging ◽

Correct Diagnosis ◽

Signs And Symptoms ◽

Fatal Disease ◽

Pulmonary Artery Sarcoma

Pulmonary artery sarcoma (PAS) is a rare and fatal disease. PAS can often be misdiagnosed as pulmonary thromboembolism. Moreover, the correct diagnosis is frequently delayed due to nonspecific signs and symptoms. The prognosis of patients with PAS is poor. We report a case of a woman with a primary PAS who was initially diagnosed with pulmonary thromboembolism.

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Gemcitabine-Induced Pulmonary Toxicity: A Case Report of Pulmonary Veno-Occlusive Disease

Clinical Medicine Insights Oncology ◽

10.4137/cmo.s26537 ◽

2015 ◽

Vol 9 ◽

pp. CMO.S26537 ◽

Cited By ~ 13

Author(s):

Célia Turco ◽

Marine Jary ◽

Stefano Kim ◽

Mélanie Moltenis ◽

Bruno Degano ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Ct Scan ◽

Left Ventricular ◽

Functional Class ◽

Occlusive Disease ◽

Heart Catheterization ◽

Systolic Pulmonary Artery Pressure ◽

Arterial Blood ◽

Metastatic Setting

Introduction Gemcitabine is a chemotherapeutic agent frequently used by for the treatment of several malignancies both in the adjuvant and metastatic setting. Although myelosuppression is the most adverse event of this therapy, gemcitabine might induce severe pulmonary toxicities. We describe a case of pulmonary veno-occlusive disease (PVOD) related to gemcitabine. Case Presentation The patient was an 83-year-old man with a metastatic pancreatic cancer who was treated by gemcitabine as first-line therapy. He was in good health and received no other chemotherapy. A dose of 1000 mg/m2 of gemcitabine was administered over a 30-minute intravenous infusion on days 1, 8, and 15 of a 28-day cycle. After a period of 6 months, a complete response was observed. Nevertheless, the patient developed a severe dyspnea, with arterial hypoxemia and very low lung diffusion for carbon monoxide. A CT scan showed diffuse ground glass opacities with septal lines, bilateral pleural effusion, and lymph node enlargement. On echocardiography, there was a suspicion of pulmonary hypertension with elevated systolic pulmonary artery pressure and normal left ventricular pressures. Right heart catheterization confirmed pulmonary hypertension and normal pulmonary artery occlusion pressure. Diagnosis of PVOD was made, and a gemcitabine-induced toxicity was suspected. A symptomatic treatment was started. At last follow-up, patient was in functional class I with near-normal of CT scan, arterial blood gases, and echocardiography. A gemcitabine-induced PVOD is the more likely diagnosis.

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Systemic Artery to Pulmonary Artery Shunt Mimicking Acute Pulmonary Embolism, Unmasked by a Multimodality Imaging Approach

Tomography ◽

10.3390/tomography8010014 ◽

2022 ◽

Vol 8 (1) ◽

pp. 175-179

Author(s):

Brieg Dissaux ◽

Pierre-Yves Le Floch ◽

Romain Le Pennec ◽

Cécile Tromeur ◽

Pierre-Yves Le Roux

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Acute Pulmonary Embolism ◽

Multimodality Imaging ◽

Lower Lobe ◽

Filling Defect ◽

Pulmonary Angiography ◽

Systemic Artery ◽

Imaging Approach ◽

The Right

In this report, we describe the functional imaging findings of systemic artery to pulmonary artery shunt in V/Q SPECT CT imaging. A 63-year-old man with small-cell lung cancer underwent CT pulmonary angiography (CTPA) for suspected acute pulmonary embolism (PE). The CTPA showed an isolated segmental filling defect in the right lower lobe, which was initially interpreted as positive for PE but was actually the consequence of a systemic artery to pulmonary artery shunt due to the recruitment of the bronchial arterial network by the adjacent tumor. A V/Q SPECT/CT scan was also performed, demonstrating a matched perfusion/ventilation defect in the right lower lobe.

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A Case of Pulmonary Artery Sarcoma

10.21203/rs.3.rs-96029/v1 ◽

2020 ◽

Author(s):

Yukang Liu ◽

Yan Hu ◽

Wei Han ◽

Jingqun Tang ◽

Qingchun Liang ◽

...

Keyword(s):

Pulmonary Artery ◽

Surgical Resection ◽

Frozen Section ◽

Lower Lobe ◽

Left Pulmonary Artery ◽

Computed Tomographic Angiography ◽

Resection Margins ◽

Pulmonary Artery Sarcoma ◽

Computed Tomographic ◽

Isolated Lung

Abstract Background: pulmonary artery sarcoma is a rare mesenchymal tumor. The prognosis of this very infrequent disease remains poor,and surgical resection is important for obtaining the best outcome.Case Presentation: A 51-year-old male patient presented to our clinic due to the finding of the isolated lung mass in the left lower lobe of the lung. Preoperative pulmonary artery computed tomographic angiography scans showed a mass with the in the left pulmonary artery and an isolated mass in the left dorsal segment of the lung (RS6).Under extracorporeal circulation the left pneumonectomy was performed, the surgical resection margins were confirmed to be tumor-free on frozen section and all lymph nodes were free of tumor. Histopathology, immunohistochemistry, as well as fluorescence in situ hybridization(FISH) indicated the diagnosis of pleomorphic rhabdomyosarcomaConclusion: This case report describes a PAS which was successfully resected with pneumonectomy and concludes that biopsy may play a limited role in confirming the pathological type and pneumonectomy should be considered in the surgical treatment of PAS.

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Multimodality imaging of a rare pulmonary artery sessile mass: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa551 ◽

2021 ◽

Author(s):

Laura Piscitelli ◽

Ilaria Dentamaro ◽

Gaetano Pezzicoli ◽

Carlo D’Agostino

Keyword(s):

Pulmonary Artery ◽

Cardiac Mri ◽

Multimodality Imaging ◽

Anticoagulation Therapy ◽

Three Dimensional ◽

Left Lung ◽

Laboratory Findings ◽

Positron Emission ◽

Superior Lobe ◽

Magnetic Resonance Imaging Mri

Abstract Background Primary pulmonary artery masses are unusual entities that mimic pulmonary embolism (PE) in clinical presentation and on imaging studies. It is necessary to perform advanced diagnostic exams, such as transesophageal echocardiography (TEE) and cardiac magnetic resonance imaging (MRI), to determine the proper diagnosis. In unclear cases, laboratory findings, morphological follow-up, and response to anticoagulant therapy can help to clarify the diagnosis. Case summary A 47-year-old previously healthy man with worsening effort dyspnoea underwent chest computed tomography (CT) for suspicion of PE, which showed a pedunculated eccentric mass at the origin of the pulmonary artery causing severe stenosis. The patient was started on anticoagulation therapy, but, after TEE and cardiac MRI, a neoplastic fibroelastic mass was suspected. Unexpectedly, 18fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT revealed a unique area of glucose uptake in the superior lobe of the left lung and not in the pulmonary artery. The biopsy was consistent with pleomorphic high-grade lung sarcoma. After 3 months of chemotherapy, a CT scan showed progression of the lung disease with no change in the arterial mass, which was therefore confirmed as pulmonary fibroelastoma. Discussion Due to the rarity of pulmonary artery tumours, they can be initially misdiagnosed as PE or a metastasis of a lung sarcoma. Three-dimensional TEE and cardiac MRI are particularly useful in differentiating tumours from PE.

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Fatality Case in a Tuberculous Meningoencephalitis Patient Coinfected with COVID-19

International Journal of Infection ◽

10.5812/iji.116891 ◽

2022 ◽

Vol In Press (In Press) ◽

Author(s):

Badrul Munir ◽

Benny Arie Pradana ◽

Widodo Mardi Santoso ◽

Ria Damayanti ◽

Catur Ari Setianto ◽

...

Keyword(s):

Case Report ◽

Respiratory Failure ◽

Ct Scan ◽

Extrapulmonary Tuberculosis ◽

Ct Scans ◽

Intensive Phase ◽

Laboratory Results ◽

Meningeal Sign ◽

Life Threatening ◽

The Brain

: Tuberculous meningoencephalitis (TBM) is the most severe, life-threatening form of tuberculosis that contributes to as much as 5% of cases of extrapulmonary tuberculosis. Emerging at the end of 2019, COVID-19 has been shown to affect various organs, including the brain. In this case report, a 21-year-old woman diagnosed with TBM, being in the intensive phase of tuberculous therapy, came with dysphagia and dysphonia as new complaints felt one day before admission accompanied by a positive meningeal sign, diplopia, and cephalgia, which became heavier after previously getting better. Cough and fever followed this complaint two days before admission. About the laboratory results, the PCR was positive for COVID-19, and CT scans showed increased leptomeningeal enhancement when compared with CT scan one month earlier. The patient received intravenous dexamethasone, anti-tuberculosis drugs, phenytoin, aspirin, oseltamivir, and hydroxychloroquine. The patient died four days after being hospitalized due to respiratory failure. This case report shows the coinfection of COVID-19 and TBM resulting in a poor tuberculosis treatment response and outcome.

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A case report on uneventful anticoagulation and persistence of type1 respiratory failure post severe COVID-19 infection in a patient of Osler-Weber-Rendu Syndrome.

10.21203/rs.3.rs-941184/v1 ◽

2021 ◽

Author(s):

Sachin Gautam ◽

Govind Mawari ◽

Mradul Kumar Daga ◽

Naresh Kumar

Keyword(s):

Case Report ◽

Respiratory Failure ◽

Pulmonary Artery ◽

Hereditary Hemorrhagic Telangiectasia ◽

Vascular Malformations ◽

Thrombus Formation ◽

Anticoagulation Therapy ◽

Kidney Injury ◽

Pulmonary Artery Hypertension ◽

Recurrent Epistaxis

Abstract Ever since the WHO's declaration of the SARS-CoV-2 pandemic, the medical literature has been focusing upon the patterns of association of SARS-CoV-2 with different diseases. Patients with Osler-Weber-Rendu Syndrome, also known as, Hereditary hemorrhagic telangiectasia (HHT), presents with recurrent epistaxis, nostril manipulations, incidental detection of multiple AVMs (Arterio-Venous Malformations), and telangiectasias over mucocutaneous tissues and internal organs. In addition, these AVMs are prone to bleed or act as a nidus for thrombus formation apart from other serious complications like chronic hypoxemia, anemia, pulmonary artery hypertension, heart failure, and cerebrovascular disease accidents. Here, we provide a case report of such a patient who was diagnosed with HHT as per 'Curaçao criteria'; having a history of multiple episodes of epistaxis, radiological evidence of AVMs over left calf, pulmonary and hepatic region, multiple telangiectasias in the splenic region and uterine vascular malformations. Upon acquiring severe COVID-19 infection, the patient developed complications like anemia, pulmonary artery hypertension, sepsis, acute kidney injury, and post COVID-19 persistence of type1 respiratory failure. Moreover, the risk-benefit ratio of anticoagulation therapy in such patients with COVID-19 infection is tricky and challenging; however, our patient was prophylactically anti-coagulated with enoxaparin for 12 days with an uneventful outcome. Keywords: Osler-Weber-Rendu Syndrome, Hereditary hemorrhagic telangiectasia, HHT, Prophylactic Anticoagulation, Covid-19, SARS-CoV-2.

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Pulmonary Artery Intimal Sarcoma Diagnosed Preoperatively by Endovascular Biopsy and Treated via Right Pneumonectomy and Pulmonary Arterioplasty

Case Reports in Pulmonology ◽

10.1155/2021/5573869 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Daiki Kato ◽

Shohei Mori ◽

Eriko Harada ◽

Rintaro Shigemori ◽

Takamasa Shibazaki ◽

...

Keyword(s):

Pulmonary Artery ◽

Preoperative Diagnosis ◽

Pulmonary Thromboembolism ◽

Main Pulmonary Artery ◽

Anticoagulation Therapy ◽

Treatment Strategies ◽

Pulmonary Artery Sarcoma ◽

Intimal Sarcoma ◽

Planning Treatment ◽

The Right

Introduction. Intimal sarcoma is a very rare tumor arising within the intima of the pulmonary artery. Preoperative diagnosis of pulmonary artery sarcoma is difficult, and the tumor is sometimes misdiagnosed as pulmonary thromboembolism. We report a case of pulmonary artery intimal sarcoma successfully diagnosed by preoperative endovascular biopsy and treated via right pneumonectomy and pulmonary arterioplasty. Presentation of a Case. A 72-year-old woman was referred to our hospital with a low-attenuation defect in the lumen of the right main pulmonary artery by computed tomography. Pulmonary artery thromboembolism was suspected, and anticoagulation therapy was administered. However, the defect in the pulmonary artery did not improve. Endovascular catheter aspiration biopsy was performed. Histological examination revealed pulmonary artery sarcoma. The patient was treated with right pneumonectomy and arterioplasty with the use of cardiopulmonary bypass. Discussion. Preoperative biopsy by endovascular catheter is worth considering for a patient with a tumor in the pulmonary artery and can help in planning treatment strategies.

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