Pulmonary artery sarcoma: Case report and review of the literature

Pulmonary artery sarcoma affecting the pulmonary valve mistaken as pulmonary vasculitis: a case report and comparative literature review

Pulmonary arterial sarcomas (PAS) are rare aggressive tumours occurring mainly in the pulmonary trunk. We report a case of PAS involving the pulmonary trunk wall and valve, with uniform wall thickening which represents an atypical imaging manifestation of this tumour. A 63-year-old male presented with vague respiratory symptoms with rapid progression. CTPA showed low density filling defects in both pulmonary arteries and PET scan showed increased uptake in the pulmonary trunk, which along with raised ESR suggested Pulmonary Vasculitis. Echo imaging showed Right ventricular hypertrophy and pulmonary stenosis. Response to steroid therapy was minimal and his symptoms worsened. A referral for second opinion was made and he was diagnosed with PAS. He underwent Pulmonary thromboendarterectomy with Pulmonary valve replacement. Post-operative histopathology confirmed the diagnosis. PAS is rare and frequently misdiagnosed. Surgical resection is not curative, but together with chemotherapy can prolong survival.

High-Grade Sarcoma of the Pulmonary Artery That Mimicked a Pulmonary Embolism in a 39-Year-Old Patient with Recurrent Miscarriages: A Case Report

Introduction

Primary pulmonary artery sarcoma is a rare malignancy with a poor prognosis, undefined treatment guidelines, and is often mistaken for a pulmonary embolism (PE) based on similar clinical presentation and radiographic findings.

Case Presentation

We present a case of a 39-year-old female with a past medical history of recurrent miscarriages who presented with a chief complaint of dyspnea. Due to a history of recurrent miscarriages, a predisposing coagulopathic condition was suspected for a PE. A V/Q scan showed high probability for a PE with bilateral perfusion defects. Subsequent CT angiographic imaging of the chest was read as positive for a massive PE. The patient was transferred to the medical ICU for tPA administration but developed worsening hypoxic respiratory failure and was transferred to an outside hospital for expert surgical consultation and thrombectomy. Intraoperative reports during thrombectomy commented on a mass within the pulmonary artery. Subsequent pathology showed a high-grade sarcoma. The patient was started on adjuvant chemotherapy with doxorubicin, ifosfamide, and MESNA; however, due to multiple comorbidities, the patient ultimately succumbed to her illness.

Conclusion

This case underscores the diagnostic difficulty in distinguishing pulmonary artery sarcomas from a PE, especially in the presence of other confounders and biases.

Pulmonary angiosarcoma: A case report of surgical treatment

Pulmonary angiosarcoma (PAS) is a malignant tumor of the vascular wall of mesenchymal origin. PAS is rare and has unknown etiology and poor prognosis. Depending on the location, angiosarcoma can lead to serious obstructive and embolic complications, as well as severe pulmonary hypertension and right ventricular heart failure. Patients with PAS are often mistakenly diagnosed with pulmonary embolism, chronic thromboembolic pulmonary hypertension, or lung tumors. Here, we present a clinical case of combined treatment of PAS.

Primary pulmonary artery sarcoma versus pulmonary thromboembolism: a multimodal imaging comparison

Primary pulmonary artery sarcoma (PPAS) is a rare malignancy that is commonly mistaken for pulmonary embolism due to similarities in clinical presentation and radiographic findings. Distinct radiographic findings to help differentiate between the two diseases are highlighted in the case presented. (1) Several nuances in various imaging modalities have been identified to help distinguish pulmonary artery sarcoma from pulmonary thromboembolic disease. (2) The wall eclipsing sign is considered pathognomonic for pulmonary artery sarcoma. (3) Positron emission tomography/computed tomography may help reduce time between diagnosis and treatment, which may ultimately prolong survival. (4) Providers should be well versed on the subtle differences on imaging to prevent future delays in diagnosis and treatment.

Pulmonary Artery Intimal Sarcoma: A Diagnostic Challenge Using a Multimodal Approach

Pulmonary artery intimal sarcoma (PAIS) is a rare tumor without clear syndromic presentation other than nonspecific symptoms of cough, dyspnea, and weight loss. This diagnosis is difficult due to challenging radiographic interpretations of multiple imaging modalities. We present a case of a 60-year-old male, who presented to his pulmonologist and underwent a CT chest with IV contrast that initially suggested primary lung carcinoma. CT angiogram showed significant vascular filling defects suspicious of an intravascular mass, rather than vascular invasion by lung lesions. The PET/CT scans further suggested a malignant process, but indistinguishable between an extravascular or intravascular etiology. Taking these results together, they suggested an intravascular malignancy, prompting a tissue biopsy, which ultimately led to a diagnosis of PAIS with metastases. Establishing a definitive diagnosis is essential as treatment and prognosis are different for sarcoma compared to carcinoma. There is no standard treatment to date, and management often includes a multidisciplinary approach involving surgery, radiation, chemotherapy, and targeted therapy. PAIS is a rare entity that cannot be diagnosed clinically and needs a multimodality approach for its diagnosis.

A Boulder in the Chest: Case of Massive Pulmonary Artery Sarcoma

A 79-year-old woman presented with dyspnea and cough. Workup revealed a pulmonary artery mass. After undergoing surgery, she was treated with adjuvant immunotherapy for an undifferentiated pulmonary artery sarcoma. Fifteen months after surgery, there was no evidence of recurrence. The case is discussed, imaging presented, and the published reports reviewed. (Level of Difficulty: Intermediate.)

Pulmonary artery intimal sarcoma: a case report and literature review

Pulmonary artery intimal sarcoma is a rare disorder arising from the intima of the pulmonary artery. Histopathology reveals that it is a tumour cell of mesenchymal origin. The signs and symptoms include chronic shortness of breath and other features of right ventricular failure, which mimic chronic pulmonary thromboembolism. The definitive diagnosis can rarely be made based on the symptoms and signs alone, and other investigations including echocardiography, computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET) are often required. The gold standard for diagnosis is tissue biopsy. The mainstay for treatment is surgery, and complete surgical resection with endarterectomy provides survival benefit. According to recent evidences, however, multimodal treatment provides better survival outcomes than monotherapy such as surgery alone. Despite the newer upcoming treatment strategies, patients with pulmonary intimal sarcoma continue to have a poor prognosis. We present a case of pulmonary artery intimal sarcoma and review the literature associated with the disease.