Primary pulmonary artery tumors easily misdiagnosed as pulmonary embolism: A review

Abstract

Primary pulmonary artery tumors (PPATs), originating from the pulmonary artery intima, are rare tumors characterized by pulmonary artery luminal occlusion and pulmonary hypertension. Diagnosis of this rare entity is a challenging dilemma with the need for a high expertise in the radiological and pathological identification of PPATs. computed tomographic pulmonary angiography of PPATs may show filling defects, which are easily misdiagnosed. The radionuclide scan, along with other imaging examinations, can assist with the diagnosis, but the pathological diagnosis requires a puncture or surgical resection. Most primary pulmonary artery tumors are malignant, with poor prognosis and lack of specificity in clinical manifestations. However, there is no unified understanding and standard for diagnosis and treatment. In this review, we discuss the status, diagnosis, and treatment of primary pulmonary artery tumors, as well as how clinicians can better understand and treat the disease.

Isolated pulmonary artery choriocarcinoma masquerading as pulmonary embolism diagnosed by endovascular biopsy

“…On MRI, tumor embolism demonstrates increased gadolinium enhancement when compared to bland emboli. On 18 F-FDG PET/CT tumor thrombus will demonstrate increased FDG uptake with the additional advantage that it can help identify a distant primary source and other sites of metastatic disease [ 1 , 2 , 5 , 7 ].…”

“…CT-guided transthoracic biopsy is one option, however given the location it poses the high risk of bleeding. Endobronchial ultrasound and transbronchial needle aspiration (EBUS-TBNA) is another option which allows better visualization of the tumor and blood flow via doppler ultrasonography, however due to increased pulmonary artery pressure and resultant bronchial artery hypertrophy, there is also a high risk of bleeding [ 2 , 8 , 9 ].…”

“…Furthermore, there were no acute or fatal complications. This does, however, require extensive training in PA catheterization and ability to use forceps of a considerable size to obtain appropriate samples [ 2 , 8 , 9 ].…”

“…Secondary involvement of pulmonary arteries and veins can be due to direct invasion from primary or secondary lung malignancy or due to tumor emboli (e.g. renal cell carcinoma) [ 1 , 2 ].…”

Outcomes of pulmonary endarterectomy for patients with pulmonary artery sarcoma

“…The role of preoperative biopsy in PAS patients remains controversial. Some studies have reported successful pathological diagnosis through CT scan-guided transthoracic aspiration, EBUS-TBNA, and ECGF biopsy ( 23 ). Among these seven patients, two using EBUS-TBNA and three of five using ECGF were confirmed to have malignancy.…”