Missed pulmonary artery sarcoma requiring radical excision and pneumonectomy

Figures

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  Pulmonary artery sarcoma invading the main and branch pulmonary arteries.

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  Figure 1. A-C, Initial CT during time of diagnosis of PE shows mass at bifurcation of the MPA with decreased filling of the RPA proximally. D-F, On preoperative cardiac CT, tumor can be seen invading into the MPA and causing full obstruction of the RPA. Extension into the LPA is difficult to determine. G-I, Postoperative cardiac CT demonstrates a patent reconstructed MPA and LPA. MPA, Main pulmonary artery; RPA, right pulmonary artery; LPA, left pulmonary artery.

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  Video 1. A step-by-step demonstration of our surgical approach for resection of bilateral PAS with pneumonectomy, and reconstruction of the pulmonary arteries and root. PAS, Pulmonary artery sarcoma. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00689-1/fulltext.

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  Figure 2. A, The RVOT and pulmonary root were harvested with cautery and scissors from the RV. B, Resected MPA, RPA, and about 50% LPA are reflected to demonstrate the tumor burden and obstruction of the RPA. C, A branch cuff allograft of about 3 cm was attached with sutures to the remaining native LPA D, Pulmonary autograft was attached with sutures to the newly reconstructed LPA branch cuff. E, Reconstruction was completed with attachment of the pulmonary autograft to the RV with sutures F, A view into the right pleural cavity showing lung adhesions to the chest wall, which were divided using cautery during pneumonectomy. RVOT, Right ventricular outflow tract; RV, right ventricle; LPA, left pulmonary artery; MPA, main pulmonary artery; RPA, right pulmonary artery.