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Weekly Chest CasesArchive of Old Cases

Case No : 1402 Date 2024-09-02

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  • Courtesy of Jiyoung Song, Ji Young Lee, Woo Hyeon Lim / Seoul National University Hospital
  • Age/Sex 39 / F
  • Chief Complaintincidental finding, never smoker
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pulmonary epithelioid hemangioendothelioma
Radiologic Findings
Fig 1: Chest PA shows multiple small nodules in both lungs.
Figs 2-4: Axial CT images with mediastinal and lung window settings reveal poorly enhancing nodules in both lungs that have grown slowly over a 2-year interval.
Fig 5: Axial PET/CT image shows multiple mildly hypermetabolic nodules in both lungs (SUVmax 2.9).
Brief Review
Pulmonary epithelioid hemangioendothelioma (PEH) is a rare, low-grade malignant vascular neoplasm of the lung. While epithelioid hemangioendothelioma can occur in various body sites and metastasize to the viscera, bones, and soft tissues, the most common sites of involvement are the liver (21% of patients), bone (14%), and lung (12%).

Clinical Presentation: PEH typically manifests as multiple bilateral lung nodules, often discovered incidentally in middle-aged women, with a mean patient age of 40 years. Symptomatic patients may experience chest tightness, shortness of breath, and difficulty breathing after exertion.

Imaging Characteristics: PEH usually presents as multiple well-defined nodules scattered throughout the lungs. Solitary lesions are rare, and nodule diameters are typically 1
References
Frota Lima, Livia Maria et al. Epithelioid hemangioendothelioma: evaluation by 18F-FDG PET/CT. American journal of nuclear medicine and molecular imaging vol. 11,2 77-86. 15 Apr. 2021

Jang, Jong Keon et al. A Review of the Spectrum of Imaging Manifestations of Epithelioid Hemangioendothelioma. AJR. American journal of roentgenology vol. 215,5 (2020): 1290-1298. doi:10.2214/AJR.20.22876

Shao, Jinchen, and Jie Zhang. Clinicopathological characteristics of pulmonary epithelioid hemangioendothelioma: A report of four cases and review of the literature. Oncology letters vol. 8,6 (2014): 2517-2522. doi:10.3892/ol.2014.2566
Keywords

No. of Applicants : 59

▶ Correct Answer : 25/59,  42.4%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - , Korea (South) DONG-HO BANG
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Osaka University , Japan AKINORI HATA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - , Korea (South) HEONSEOK LEE
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - TB centre kasaragod. , India rikhy krishnan
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 7/59,  11.9%
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - , Japan SHUNJIRO NOGUCHI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Mie university , Japan SHIKO OKABE
▶ Semi-Correct Answer : 1/59,  1.7%
  • - GHICL , France MANUEL TOLEDANO
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