Pulmonary artery tumour–embolism diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration

To the Editors: A 61-yr-old female was diagnosed with pulmonary embolism. She had a history of poorly differentiated thyroid cancer with follicular cell phenotype, and had first been treated in 2006 by thyroidectomy and radioactive iodine-131. Local relapse (cervical nodes) had occurred within 3 months and required five cycles of chemotherapy, consisting of cisplatin and doxorubicin, followed by cervical radiotherapy and surgical resection of residual nodes. 2 yrs later during follow-up, abnormal 18F-fluorodeoxyglucose (FDG) uptake was described on positron emission tomography (PET)/computed tomography (CT) in the left thoracic hilar regions. CT pulmonary angiography showed a filling defect in the left lower lobe pulmonary artery and at the origin of the lingular artery; no delayed embolism enhancement was observed. It was considered to be a pulmonary embolism, and anticoagulation was initiated. 6 months later, follow-up imaging showed stability of both FDG uptake and CT pulmonary angiography images, and anticoagulation was continued. 10 months later, follow-up showed a right pulmonary upper lobe nodule on CT scan associated with high FDG uptake on PET/CT, and thyroglobulin ascension. This nodule was considered to be a thyroid cancer metastasis and treated by CyberKnife radiotherapy. As FDG uptake and thyroglobulin …