Application of Perioperative Transesophageal Echocardiography in Resection of Pulmonary Artery Sarcoma: A Case Report

Pulmonary artery sarcoma (PAS) is an extremely rare and aggressive malignancy, often misdiagnosed as pulmonary thromboembolism due to overlapping clinical presentations. This case report describes a 35-year-old female with progressive dyspnea and syncope, initially managed as pulmonary embolism. Despite anticoagulation therapy, persistent intracardiac masses were identified, prompting urgent surgical intervention. Transesophageal echocardiography (TEE) played a pivotal role intraoperatively, revealing a large mobile mass obstructing the pulmonary artery and causing hemodynamic instability. Following cardiac arrest, emergency surgery with extracorporeal circulation support was performed. Postoperative TEE demonstrated reduced mass size and improved pulmonary blood flow, although histopathological examination confirmed malignant carcinosarcoma. Unfortunately, the patient experienced recurrent syncopal episodes post-discharge and succumbed to the illness despite resuscitation efforts. This case highlights the diagnostic challenges of PAS and the indispensable role of TEE throughout the perioperative period. TEE provides real-time hemodynamic monitoring, precise tumor localization, and assessment of right ventricular function, facilitating timely surgical decisions. Intraoperatively, TEE continuously monitors for sudden hemodynamic changes, such as right ventricular outflow tract obstruction, and guides therapeutic interventions. Postoperatively, TEE aids in evaluating surgical outcomes, detecting residual masses or complications, and informing postoperative management strategies. Multi-planar TEE assessment, especially the ME gastric view, is crucial for comprehensive evaluation. This case underscores the importance of integrating TEE into the management of PAS to optimize patient outcomes.