Spindle cell sarcoma of pulmonary artery mimicking thromboembolism with lung metastasis detected in fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography

Abstract

Pulmonary artery sarcoma (PAS), although rare, must be considered in the differential diagnosis of pulmonary thromboembolism (PTE). This tumor is highly malignant and the prognosis is very poor. As much as the standardized uptake values (SUVs) at fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) have helped in differentiating between benign and malignant tumors, visualization of a low-attenuation filling defect within a pulmonary artery on contrast-enhanced chest computed tomography (CT) can be suggestive of a malignancy, such as PAS, if the lesion shows high FDG uptake at PET. We present a case of PAS that showed high FDG uptake on integrated FDG PET/CT and with lung metastasis. Patient underwent endoscopic bronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA), which confirmed spindle cell sarcoma.

Imaging Diagnosis—multimodality Findings in an Adult Dog With Primary Sarcoma of the Pulmonary Artery and Myocardial Metastases

“…Radiographically no definitive diagnosis of primary pulmonary artery disease could be made as the noted dilation and tortuosity of the pulmonary arteries could also be caused by other disease. It is important to note, that over half of the pulmonary artery sarcomas in human patients are misdiagnosed based on radiographic findings and are thought to be secondary to thromboembolic disease …”

Pathway and application value of exploration of the pulmonary artery by endobronchial ultrasound

“…For central thromboembolism patients with stable haemodynamics, at least one pulmonary embolism is detected by EBUS for each enrolled patient (7). Non-thromboembolic pulmonary vascular lesions include pulmonary artery sarcoma (16)(17)(18)(19)(20), pulmonary artery metastasis of tumors (21)(22)(23)(24) or septic pulmonary artery embolisms (25,26). Considering the high sensitivity and specificity of EBUS-TBNA in the diagnosis of mediastinal and hilar tumors, and the high risk associated with these tumors for pulmonary embolism, the exploration and evaluation of the pulmonary artery to identify possible pulmonary embolism when performing EBUS-TBNA has potentially important clinical significance.…”

Primary pulmonary artery sarcoma with intrapulmonary metastases based on PET/CT imaging: a case report and literature review

“…The imaging findings of echocardiography, and pulmonary vascular magnetic resonance imaging were similar to those of pulmonary embolism, the 'wall eclipsing sign' on pulmonary artery computed tomography angiography is typical characteristic for diagnosis of PAS (1). Pulmonary artery sarcoma could manifest increased FDG uptake on PET/CT imaging, however, pulmonary artery thromboembolism usually shows radioactive defect, which is important for the differential diagnosis between pulmonary artery sarcoma and pulmonary thromboembolism, and 18 F-FDG PET/ CT have been shown useful in the diagnosis of pulmonary artery sarcoma and also could contribute to an accurate diagnosis for determining pulmonary artery malignancy (4,11,12). In addition, 18 F-FDG PET/CT could provide whole body condition through once examination, and whether the tumor has distant metastasis.…”