Lower Limb Myxofibrosarcoma Presenting as a Pulmonary Tumour Embolism: A Case Report

Figures

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  Figure 1. Initial CT of the chest post-contrast phase: (A) coronal maximum intensity projection view in soft tissue windows and (B) axial view. Coronal CT image demonstrates an occlusive filling defect in the left lateral basal segmental pulmonary artery with a distended lumen (red arrow). Axial CT image showing a cluster of nodules with a tree-in-bud pattern evident in the lateral basal segment of the left lower lobe (yellow arrow).

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  Figure 2. CT pulmonary angiogram completed three months after the initial presentation: (A) maximum intensity projection coronal view and (B) axial view. Coronal CT image demonstrates an occlusive tumour in the lateral basal segmental pulmonary artery with an irregular beading appearance, branching centrilobular nodules, and persisting luminal distension (red arrow). A peripheral lung infarct can also be seen in the right lower lobe (blue arrow). Axial CT image demonstrates persisting tree-in-bud pattern evident in in the lateral basal segment of the left lower lobe (yellow arrow).

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  Figure 3. Axial section of fludeoxyglucose (18F) (FDG) positron emission tomography. The image demonstrates mild FDG activity of the thrombus in the lateral basal segmental branch of the left lower lobe (orange arrow).

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  Figure 4. Cardiac MRI: axial T1 image at the level of the main pulmonary artery. The image demonstrates T1 intermediate-signal intense intraluminal lesions in the right pulmonary artery and posterior segmental pulmonary artery of the right upper lobe (red arrow).

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  Figure 5. Lateral right knee radiographs: (A) day two post after the right knee replacement, (B) re-presentation seven months post-surgery with a new right knee swelling, and (C) most recent radiograph nine months post-surgery. The image demonstrates progressive ill-defined lytic change at the proximal fibula (blue arrow) across serial right knee radiographs over time. The most recent radiograph demonstrates a transverse fracture at the proximal shaft, compatible with pathological fracture (red arrow), periosteal reaction reminiscent of an aggressive process, and a large high density knee joint effusion/haemarthrosis.

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  Figure 6. Coronal T1 fat-suppressed MRI of the right knee. The image demonstrates a large soft tissue mass involving the bones and soft tissue of the right knee. Artefacts from the prosthesis can be noted.

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  Figure 7. Coronal CT of the chest from staging chest-abdomino-pelvic CT six months after the initial presentation. The image demonstrates progressive bilateral tumour thrombi in pulmonary arterial branches with luminal distension.