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Weekly Chest CasesArchive of Old Cases

Case No : 1491 Date 2026-05-18

  • Courtesy of Sohee Park / Asan Medical Center
  • Age/Sex 36 / F
  • Chief ComplaintAbnormality on health check-up chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pulmonary epithelioid hemangioendothelioma
Radiologic Findings
Fig 1-4. Chest radiograph and chst CT images show numerous well-defined tiny (<10mm) noncalcified nodules of random distribution scattered throughout the lungs.
Fig 5. The 18F-FDG PET/CT scan shows nodules without significant hypermetabolism.
Brief Review
Pulmonary epithelioid hemangioendothelioma is a rare vascular neoplasm, with an intermediate course between hemangioma and conventional angiosarcoma. It is often diagnosed asymptomatically in middle-aged patients and tends to be more common in female.
The most common CT finding of pulmonary epitheloid hemangioendothelioma is the presence of multiple discrete nodules. The nodules range in size up to 2cm but most are less than 1cm in diameter. On serial CT examinations, these lesions have little or no growth. Other findings include multiple reticulonodular opacities mimicking hematolymphangitic metastasis and diffuse infiltrative pleural thickening mimicking malignant pleural mesothelioma or diffuse pleural carcinomatosis.
Unilateral single nodules may be surgically removed. Patients with diffuse lung lesions are mainly treated with chemotherapy, although no single chemotherapy agent has demonstrated efficiency in treating pulmonary epitheloid hemangioendothelioma.
The prognosis varies with spontaneous regression, and some have blood vessels, lymphatics, pleural cavities, and distant hematogenous spreads. The poor prognostic factors of PEH include the presence of respiratory symptoms or pleural effusion revealed by chest radiography on presentation; extensive intravascular, endobronchial or interstitial tumor spreading, hepatic metastases; peripheral lymphadenopathy; the presence of spindle cells in the tumor; and, particularly, pleural hemorrhagic effusions and hemoptysis. The 5-year survival probability is 60%.
References
1. Mesquita RD, Sousa M, Trinidad C, Pinto E, Badiola IA. New insights about pulmonary epithelioid hemangioendothelioma: review of the literature and two case reports. Case Rep Radiol 2017;2017:5972940
2. KS Lee, J Han, Chung MP, YJ Jeong. Radiology Illustrated Chest Radiology 2014 Springer p.190
3. Ye B, Li W, Feng J, Shi JX, Chen Y, Han BH. Treatment of pulmonary epithelioid hemangioendothelioma with combination chemotherapy: Report of three cases and review of the literature. Oncol Lett. 2013 May;5(5):1491-1496.
Keywords

No. of Applicants : 75

▶ Correct Answer : 17/75,  22.7%
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Teikyo University Hospital, Mizonokuchi , Japan TOSHIHIRO FURUTA
  • - Nara Medical University , Japan AYA YAMADA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) OHMIN KWON
  • - Chonbuk National University Hospital , Korea (South) SEUNG HO LEE
  • - , Japan SHUNJIRO NOGUCHI
  • - GOP Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - The First Affiliated Hospital of Nanjing Medical University , China TENG ZHANG
  • - URN , Japan PROTON SPIN CHAN
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 11/75,  14.7%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - Chonbuk National University Hospital , Korea (South) EUNCHONG LEE
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Chonbuk National University Hospital , Korea (South) JUNGHOON OH
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Korea (South) JIYUN KIM
  • - Fukuoka Central Hospital , Japan YUKIHISA TAKAYAMA
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