Pulmonary Artery Intimal Sarcoma Mimics Recurrent Pulmonary Artery Embolism

Abstract

Deep vein thrombosis and pulmonary embolism (PE) are the third most common cardiovascular condition. Pulmonary artery intimal sarcoma (PAIS) is a rare tumour and is often misdiagnosed as a PE. This case report presents a 50-year-old man with fever, dyspnoea, cough and thoracic pain since a month. The patient had a history of two PE episodes. After diagnostic screening for tumour, including laboratory parameters, transthoracic echocardiography, computed tomography scan and positron emission tomography-computed tomography scan, PAIS was diagnosed. Unexplained recurrent PE should raise suspicion of a tumour or PAIS.

Learning points: Recurrent pulmonary embolism should raise suspicion for tumours.Imaging and histopathology play a crucial role in diagnosis of pulmonary artery intimal sarcoma.Surgical resection as the primary treatment for pulmonary artery intimal sarcoma.

Keywords: Pulmonary embolism; angiosarcoma; cardiovascular events.

Figure 1

Computed tomography pulmonary angiography 09/2021. Thrombotic occlusion of the left inferior pulmonary artery with a small pleural effusion (arrows).

Figure 2

Computed tomography pulmonary angiography 12/2021. Persistent thrombotic occlusion of the left inferior pulmonary artery, new findings: partial thrombotic occlusion of the left superior pulmonary artery (arrow).

Figure 3

Transthoracic echocardiography 03/2022 (parasternal short axis). RVOT right ventricular outflow tract. Abbreviation: PV, pulmonary valve; PA, pulmonary artery.

Figure 4

Computed tomography pulmonary angiography 03/2022. Complete occlusion of the left pulmonary artery.

Figure 5

F-18 FDG positron emission tomography-computed tomograohy03/2022. Tumour-related malignant metabolic increase in the left pulmonary artery (red circle).