Thromboembolism in Pulmonary Artery Sarcoma

Abstract

Pulmonary artery sarcoma, although rare, must be considered in the differential diagnosis of pulmonary thromboembolism. Clinically and radiologically, it may imitate pulmonary embolism, making diagnosis difficult and delaying treatment. Patients often have no symptom resolution despite therapeutic anticoagulation. Visualization of filling defects within a pulmonary artery on contrast-enhanced CT cannot reliably differentiate between pulmonary thromboembolism and malignant lesions like leiomyosarcoma. FDG PET-CT offers the potential for identification of malignant lesions. The authors report a case with pulmonary artery thromboembolism due to thrombi formed on a pulmonary artery leiomyosarcoma. Integrated FDG PET-CT showed no FDG-uptake along the major part of the filling defect within the right main pulmonary artery suggesting blood clot and increased uptake along the posterior wall of the right main pulmonary artery and the left lower lobar artery suggesting malignancy.

Whole body [18F]fluorodeoxyglucose positron emission tomography imaging for the diagnosis of pacemaker or implantable cardioverter defibrillator infection: a preliminary prospective study

“…Conversely, no false-positive cases were reported. Recent blood thrombi have been reported to show 18 F-FDG uptake [15,16], but the inflammatory process that can be subsequently induced is probably less than that induced by septic foci. This point needs to be confirmed in further studies, as no such case actually occurred in the present series.…”

Endobronchial ultrasound-guided transbronchial needle aspiration of pulmonary artery tumors: A systematic review (with video)

“…In many instances, vascular tumors of the mediastinum are suspected after failure of anticoagulation therapy with progression and extension of intravascular lesions [ Figure 1 ]. [ 17 18 19 20 21 22 ] In patients undergoing PET scan for cancer staging or surveillance, the finding of an intravascular fluorodeoxyglucose (FDG)-avid lesion should raise suspicion for intravascular metastasis over pulmonary embolic disease. PET/CT may be helpful to differentiate between PA tumor and PA thrombotic disease.…”

Tomografia por emissão de pósitrons com 18F fluordesoxiglicose como exame não invasivo para o diagnóstico de sarcomas primários de artéria pulmonar

“…In the two cases reported here, there was positive radiotracer uptake in the same regions as those corresponding to the filling defects seen on CT angiography. (9)(10)(11)(12)(13) Since PET is based on an assessment of tumor metabolic activity, it has high sensitivity and high negative predictive value for assessing lung neoplasms. (14,15) Because of the difficulty in performing surgical biopsy in some cases, together with the risks of the procedure, especially in patients with pulmonary hypertension, we emphasize the importance of FDG-PET as a noninvasive tool for the diagnosis of suspected cases of vascular neoplasms of the lung.…”