Not always embolism: A case of pulmonary artery intimal sarcoma – The role of the radiologist in early diagnosis

Figures

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  Fig. 1. The patient's chest X-ray was taken because of the suspicion of pneumonia. The posteroanterior (PA) views of the chest radiograph show the presence of an area of parenchymal radiopacity, with the bronchovascular bundles thickening in the right suprabasal region (white arrow).

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  Fig. 2. Axial CTA scans demonstrate the characteristic sign of PAIS. A hypodense area extends along the entire left wall of the common pulmonary trunk (white arrow), resembling the wall-eclipsing sign. The polylobulated margin (asterisk) depicted on the luminal side is another differential element with CPE.

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  Fig. 3. Same CTA examination, in a scan acquired at the pulmonary veins level, demonstrates other peripheral segmental branches' involvement, with occlusion of the pulmonary arterial branches for the middle lobe (white arrow). These may be findings of SIAP advanced stages.

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  Fig. 4. Recurrence and progression of PAIS after surgical resection. Staging CECT examination shows the involvement of common pulmonary truncus with extension to the valve plane (white arrow in A), the involvement of right pulmonary artery (white arrow in B) and left pulmonary artery (white arrow in C), and also the involvement of the peripheral branches (white arrow in D).

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  Fig. 5. Axial CTA images (A and B) demonstrate some endoluminal filling defects of pulmonary arterial vessels in CTA (arrows), often referred to as CPE.

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  Fig. 6. CTA image shows the presence of a pulmonary endoluminal filling defect localized in the proximal portion of the common pulmonary trunk affecting the valve plane too (white arrow), a rare localization in PE.

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  Fig. 7. Characteristic of PAIS disease. The presence of acute angles between the lesions and the walls of the vessel (white arrows), demonstrated in axial CT scans, is a finding that helps us to distinguish SIAP from PE.

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  Fig. 8. ″Cauliflower-like” morphology. Axial CT images demonstrate the presence of endoluminal filling defects, with adhesion to the wall and convex and finely irregular morphology on the luminal side (white arrows in A and B). This aspect is very specific to PAIS.

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  Fig. 9. Follow-up CT evaluation. Some areas of parenchymal consolidation, with irregular margins and adhering to the costal pleura, are appreciated in the dorsal segment of the upper right lobe (white arrows in A and B) and in the anterior segment of the upper left lobe (arrowhead in C). These alterations correspond to repetitive lesions of the disease.