Case Report: Right pulmonary artery resection with artificial vascular graft replacement under cardiopulmonary bypass for pulmonary artery angiomatoid fibrous histiocytoma

Figure 1. (a) chest CT shows an irregular filling defect in the right pulmonary artery trunk; (b) CTA of the thoracoabdominal aorta reveals a filling defect in the right pulmonary artery trunk, with involvement of the right upper lobe artery and right interlobar artery, distal narrowing, and sparse branching; (c) PET-CT demonstrates a patchy low-density shadow in the right pulmonary artery, measuring approximately 2.3*1.8*1.4 cm, with increased FDG uptake (SUVmax ∼10.0). No significant enlargement is observed in the mediastinal or bilateral hilar lymph nodes.

Figure 2. The intraoperative exposure: the ascending aorta was transected and retracted, providing optimal exposure of the right pulmonary artery tumor, the artery itself, and the surrounding tissues. Left heart venting (cannulation site: right superior pulmonary vein); SVC, superior vena cava; IVC, inferior vena cava.

Figure 3. (a) the tumor was completely excised. (b) The tumor measured 4.5 × 3 × 2.5 cm, with a smooth, grayish-red to dark-brown surface and soft consistency, and was attached to the inferior wall with a 3 × 2.5 × 1.5 cm pedicle; (c) An artificial vascular graft was anastomosed to both the root of the right pulmonary artery and its first branch.

Figure 4. (a) H&E, 10 × 10. (Pulmonary artery mass) Tumor cells are spindle-shaped, with mild-moderate atypia, stromal myxoid degeneration and infiltration of lymphocytes and plasma cells around the periphery; (b) Fluorescence in situ hybridization, ×1,000. MDM2 (−, no amplification); EWSR1 (+, breakage).

Figure 5. (a,b) follow-up chest CTA demonstrates patency of the artificial vascular graft with no significant filling defect observed; (c) Two-month postoperative chest CT reveals that the right pulmonary artery trunk is narrower than the contralateral side, but no obvious filling defect is seen within it.