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Weekly Chest CasesArchive of Old Cases

Case No : 1055 Date 2018-01-15

  • Courtesy of Mi Jung Park, MD., Kyung Nyeo Jeon, MD. / Gyeongsang National University, Gyeongsang National University Changwon Hospital
  • Age/Sex 53 / M
  • Chief ComplaintDyspnea for several months
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Pulmonary artery sarcoma
Radiologic Findings
Figs 1. Chest PA shows oligemia and hyperlucency in left lung.
Fig 2-3. Chest enhanced CT scan show peripheral filling defect in both main, lobar and segmental pulmonary arteries. Especially, central blood flow is preserved in the left main pulmonary artery.
Fig 4. After surgical resection of pulmonary artery mass, follow up chest PA shows multiple lung nodules in left lung.
Fig 5. PET CT shows focal FDG uptakes in left main pulmonary artery and left upper lobe.
Brief Review
Pulmonary artery sarcoma is rare tumor (0.001%) and arises from the intimal layer of the pulmonary artery. The common symptoms are dyspnea, cough, hemoptysis, weight loss, fever, and constitutional symptoms. This tumor can frequently be misdiagnosed as chronic pulmonary thromboembolism. CT and PET are useful tools for diagnosis of pulmonary artery sarcoma. Contrast-enhanced CT can detect an eccentric filling defect or complete occlusion of the proximal or main pulmonary artery, the expansion of the involved arteries, and extraluminal tumor extension. These CT findings can also be seen in cases of extensive pulmonary thromboembolism. FDG-PET may be useful in differentiating pulmonary thromboembolism and pulmnary artery sarcoma, as blood thrombi do not take up 18F-FDG, whereas a malignant tumor. However, some reports indicate that PASs may not always show high FDG uptake. Metastasis can occur in the lung (50%) and other organs (16%). The prognosis is poor, and survival time is usually 1-2 years. Surgical resection decreases the clinical symptoms and improves the survival time of patients. Efficacy of chemotherapy or radiotherapy remains controversial.
References
1. Pulmonary Artery Sarcoma - Multimodality Imaging. J Clin Imaging Sci. 2016; 6: 45
2. Looking beyound the thrombus; issentials of pulmonary artery imaging on CT. Insights into imaging 2014; 5(5); 493-506
Please refer to
Case 930 Case 302 Case 201 Case
Keywords
Pulmonary artery, Vascular, Neoplasm_Malignant,

No. of Applicants : 109

▶ Correct Answer : 67/109,  61.5%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - , Korea (South) HANKYUL KIM
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) HAYEON LEE
  • - Prince Sattam ibn Abdulaziz University hospital , Saudi Arabia ELBAGIR MOHAMED NASSIR
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Kyemyung University Dongsan Hospital , Korea (South) MINJAE GU
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The Jikei university , Japan TAKU GOMI
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gwangju City hospital , Korea (South) HYUNGWOO OH
  • - HHS , Canada S LEE
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Okayama Red Cross Hospital , Japan KAZUAKI MUNETOMO
  • - Kurashiki Central Hospital , Japan TORU KONISHI
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Ewha Womans University Medical Center , Korea (South) YOUNGSUN KO
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - Other , Korea (South) JIN YOUNG KIM
  • - , United Arab Emirates MUNA ABDELLATIF ALMULLA
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) SEONGSU KANG
  • - Kyemyung University Dongsan Hospital , Korea (South) NAM YEOKYOUNG
  • - , Korea (South) HYERIN KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - Escola Paulista de Medicina , Brazil RENATO MASSON DE ALMEIDA PRADO
  • - District TB centre, kasaragod,India , India rikhy krishnan
  • - VENKATESHWAR HOSPITAL NEW DELHI , India RAKESH BHATIA
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Chonnam National University Hospital , Korea (South) BYEONGHAK SIM
  • - , Korea (South) WUNHA LEE
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - , Brazil THIAGO FAGUNDES
  • - Private sector , Greece VASILIOS TZILAS
  • - Hamamatsu university school of medicine , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - University of Utah , United States AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Samsung Medical Center , Korea (South) HYUN JUNG YOON
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 20/109,  18.3%
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Ulsan University Hospital , Korea (South) SOYEOUN LIM
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Chonnam National University Hospital , Korea (South) GUNSU KIM
  • - seoul national university hospital , Korea (South) yunsoo jeong
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Seoul National University Hospital , Korea (South) JI EUN KIM
  • - Gifu University Hospital , Japan Yo Kaneko
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Sarawak General Hospital , Malaysia POHSEN TAY
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Kyemyung University Dongsan Hospital , Korea (South) JUNG GUEN CHA
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