An Unusual Cause of Tree-in-Bud Pattern: Pulmonary Intravascular Tumor Embolism Caused by Chondrosarcoma

Abstract

We report the case of a 45-year-old man who initially presented with chondrosarcoma of the left femur that was treated surgically. Follow-up chest computed tomography (CT) performed 3 years later showed multiple small nodules with a tree-in-bud branching pattern and larger elongated opacities with beaded contours. These findings raised the suspicion of intravascular tumor embolism. Pulmonary CT angiography demonstrated intravascular thrombosis and dilated and beaded peripheral pulmonary arteries. The tumoral origin of the thrombus was confirmed by lung biopsy.

Pulmonary Tumor Embolism and Pulmonary Tumor Thrombotic Microangiopathy Causing Rapidly Progressive Respiratory Failure: A Case Series

“…1,2,24,25 The presence of dilated, beaded, or tree-in-bud appearance of pulmonary arteries on CT pulmonary angiography is suggestive of PTE and PTTM. 26 An elevated blood D-dimer level and serum VEGF level, PH on right heart catheterization, multiple small subsegmental perfusion defects (mottled/beaded appearance) on ventilation/ perfusion study can suggest PTE and PTTM, even in situations where CXR, high-resolution CT chest, and CT angiography are unrevealing. 2,18,19 It is imperative for these patients to be screened for an underlying malignancy.…”

Pulmonary micro‐tumor emboli resulting in paradoxical emboli: a case report

“…In these cases, FDG-PET scan has been described to differentiate macroscopic PTE involving the main pulmonary artery from pulmonary thromboembolism. 17 Frequently, however, CTPA reveals indirect signs of PTE according to the size of tumor emboli, including a beaded aspect of the peripheral pulmonary arteries, 18 centrilobular nodules with a tree-in-bud pattern, 19 and non-specific ground-glass opacities. 11 It is noteworthy, however, that a normal CTPA alone cannot rule out a diagnosis of PTE.…”

Many Faces of Bronchiolitis and Organizing Pneumonia

“…Similar cases have been reported in pancreatic adenocarcinoma, 12 leiomyosarcoma, 13 and chondrosarcoma. 14 Pulmonary tumor thrombotic microangiopathy is a distinct specific condition characterized by fibrocellular intimal proliferation of the small pulmonary arteries and arterioles in patients with metastatic carcinoma, where tumor emboli do not directly occlude affected vessels but induce both local activation of coagulation and fibrocellular intimal proliferation, which eventually lead to stenosis or occlusion of the vessels. Von Herbay et al 15 described this condition in 21 patients out of 630 consecutive autopsy cases with carcinoma (3.3%), of which 19 had adenocarcinoma (with 11/19 gastric carcinomas).…”