Primary and Secondary Pulmonary Artery Neoplasia Mimicking Acute Pulmonary Embolism

Abstract

Two cases of rare pulmonary neoplastic lesions (primary pulmonary artery sarcoma and pulmonary carcinosarcoma) directly involving the pulmonary artery and presenting with findings mimicking acute pulmonary embolism are discussed. Although this represents an unusual presentation for these two lesions, they should be included in the differential diagnosis of acute pulmonary embolism in patients presenting with somewhat atypical clinical, isotopic, and radiological features. Serial lung scans followed by angiography will prove useful in arriving at the correct diagnosis.

The value of lung scintigraphy in the diagnosis of pulmonary embolism

“…Totally absent perfusion of a complete lung is a rare finding, and one should be especially aware of congenital vascular abnormalities Pulmonary veno-occlusive disease [39] Fibrotic sarcoid [42] Perfusion defect with normal ventilation Acute pulmonary embolism [6-8, 19, 33] Old pulmonary thromboembolism [44,45] Atelectasis [48] Metastatic lung disease [49] (Microscopic) tumour embolism [51,52] Post radiotherapy [54] Haemangioendotheliomatosis [56] Traumatic pulmonary artery pseudoaneurysm [58] Air embolism [61] Idiopathic pulmonary fibrosis [63,64] Oesophageal hiatus hernia [65] Positive end expiratory pressure ventilation [67] Diaphragm paralysis [69] Mitral valve disease [71] Dogworm infestation [33] Congenital vascular abnormalities [36][37][38] Tumours in the hilar region [40,41] Histoplasmosis [43] Emphysema [46,47] Pneumonia [33,42] Sarcoidosis [49] Lymphangitis carcinomatosis [50] Intravenous drug abuse [53] Pulmonary artery sarcoma [49,55] Systemic arterial supply [57] Pulmonary contusion [59,60] Takayasu's arterities [49,62] Histoplasmosis [43] Intrathoracic stomach …”

“…1) [36][37][38]. Another cause of unilateral absence of lung perfusion is a tumour mass in the hilar region [40,41]. Pulmonary veno-occlusive disease may also mimic pulmonary thromboembolism, but the ante-mortem diagnosis is difficult [39].…”

“…Bronchial carcinoma and other malignancies have been shown to cause perfusion defects [40,41,[49][50][51][52]. With centrally located tumours one can expect both matched and mismatched defects (Fig.…”

Pulmonary Vascular Sarcomas: Clinicopathologic Analysis of 14 Cases

“…3 In addition, the absence of predisposing factors for thromboembolism, the persistence of symptoms despite anticoagulation therapy, and the unilateral distribution of a massive perfusion defect indicate the possibility of pulmonary artery sarcoma. 1,18 In our series, the case presenting as a bronchial mass was unique in that the disease appeared to be an intractable asthma. The symptom of bronchial obstruction like in case 3 has been reported once previously.…”

Chronic Thromboembolic Pulmonary Hypertension: Diagnosis and Treatment

“…It may detect 9 otherwise occult interstitial disease. If pulmonary hypertension is present, chest CT may detect mediastinal abnormalities such as tumor or fibrosing mediastinitis [22][23][24] that might involve central pulmonary arteries and not be evident on the standard chest radiograph. The chest CT may (unusually) actually demonstrate chronic thrombi in a central pulmonary artery.…”