대한흉부영상의학회 Weekly Chest Cases

Case No : 1470 Date 2025-12-22

Courtesy of Mihyun Yang / Asan medical center
Age/Sex 59 / F
Chief ComplaintChronic sputum

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6

Diagnosis With Brief Discussion

Diagnosis: Pulmonary artery sarcoma
Radiologic Findings: Fig 1. Chest PA shows prominent left hilar pulmonary vasculature.
Fig 2 - 5. Contrast enhanced axial CT images show voluminous and eccentric filling defect in left interlobar to left lower segmental/subsegmental PAs and left lingular segmental PA.
Fig 6. PET-CT demonstrates hypermetabolic lesion along the left pulmonary artery.
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
Keywords

No. of Applicants : 75

▶ Correct Answer : 66/75, 88.0%

- Funabashi General Hospital , Japan MANABU AKIMOTO
- Kyeongpook National University Hospital , Korea (South) JOHN BAEK
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- , Japan SUZUNE TSUKAMOTO
- medical scanning , Japan HIROAKI ARAKAWA
- The University of Tokyo Hospital , Japan ISSEI FUKUDA
- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- Shiga University of Medical Science , Japan AKITOSHI INOUE
- Kyoto University , Japan AKIHIKO SAKATA
- Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
- , Turkey ARMAGAN SARAC
- Oita university , Japan AYUMI KAMEI
- Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
- , Korea (South) KYUNG HYUN WOO
- the First Affiliated Hospital of NanJing Medical University , China AIPING CHEN
- , Italy PAOLO BALDASSARI
- , France CHARLES DAMIEN
- Chonnam National University Hospital , Korea (South) JUNYEOL YANG
- Kyeongpook National University Hospital , Korea (South) JUNGMIN LEE
- Other , Korea (South) SEONGSU KANG
- , Korea (South) JIN YOUNG LEE
- Chonbuk National University Hospital , Korea (South) YONG HWAN JO
- Secomedic Hospital , Japan FUMINORI MIYOSHI
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Seoul Medical Center , Korea (South) HYUK GI HONG
- University of Yamanashi , Japan TAKAAKI HASHIMOTO
- Osaka University , Japan AKINORI HATA
- University of Yamanashi , Japan HIROYUKI MORISAKA
- , Japan HIROKI MIYAZAKI
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Nara Medical University , Japan AYA YAMADA
- , Japan YOSHIKI ISHII
- Japanese Red Cross Otsu Hospital , Japan JUN YOSHIDA
- , Japan KENTARO KOTANI
- Other , Korea (South) KI-NAM LEE
- The Catholic University of Korea Yoeuido St. Mary , Korea (South) OHMIN KWON
- Chonbuk National University Hospital , Korea (South) YEEUN LEE
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- , Japan SHUNJIRO NOGUCHI
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
- , Japan MASAMICHI IWAI
- Shiga General Hospital , Japan YUSAKU MORIBATA
- Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- Seoul Medical Center , Korea (South) YONGJOO LEE
- Samsung Medical Center , Korea (South) DONGYOUNG JEONG
- Dokkyo Medical University , Japan HIROAKI ARAKAWA
- Seoul Medical Center , Korea (South) HANSEUL CHO
- , Japan TOMOHIRO KAWAJI
- Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
- , Japan MATSUNO MAI
- Paras hospital, Panchkula , India SHALEEN RANA
- Kyoto University , Japan SHO KOYASU
- Kobe Children , Japan SHUHEI NORIMOTO
- Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Fukuoka university , Japan KEISUKE SATO
- Kantou Rousai Hospital , Japan KAORU SUMIDA
- Matsunami General Hospital , Japan TARO TAKEDA
- Ehime University , Japan KOTARO MATSUMOTO
- , Japan YUMI MAEHARA
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- University of Yamanashi , Japan KOJIRO ONOHARA
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 4/75, 5.3%

- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
- Nara medical university , Japan HIROHIDE WATANABE
- The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1470 Date 2025-12-22

Discussion

No. of Applicants : 75