Pulmonary thromboembolic disease or pulmonary artery intimal sarcoma: Case report and literature review

Figures

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  Figure 1.. Pulmonary artery CT angiography examination prior to anticoagulation treatment. (A) Left lower main pulmonary artery, (B) its proximal branch and (C) its distal branch were observed to have a large mural filling defect, which filled the lumen (red arrow). No filling defect was noted in the main trunk of the right pulmonary artery and its branches.

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  Figure 2.. Chest CT re-examination after 6 months of anticoagulation. Multiple solid nodules of different sizes. Lesions with diameters of (A) ~2.81 cm, (B) ~2.47 cm, (C) ~2.24 cm and (D) ~1.73 cm were noted in the left hilum and left lung (red arrow); a certain number of these nodules adhered to the pleura. The larger nodule had the following dimensions: 4.2×3.3 cm.

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  Figure 3.. Pulmonary artery CTA examination following 6 months of anticoagulation treatment. Small nodular filling defects were observed in (A) the right main pulmonary artery (red arrow) and (B) right middle pulmonary artery (red arrow). (C) Multiple irregular filling defects were noted in the left main pulmonary artery (red arrow).

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  Figure 4.. Pulmonary perfusion imaging after 6 months of anticoagulation. A limited radioactive distribution was noted in the anterior part of the left upper lobe, whereas the remainder of the left lung and the anterior segment of the right upper lobe demonstrated a sparse radioactive distribution-defect area (red arrow). No abnormal radioactive distribution was noted in the remainder of the right lung. RPO, right posterior oblique; LPO, left posterior oblique; RL_P, right lateral position; LL_P, left lateral positions; RAO, right anterior oblique; LAO, left anterior oblique.

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  Figure 5.. PET-CT examination after 6 months of anticoagulation. Thickening of the soft tissue in the left pulmonary artery and formation of a mass with mild FDG uptake (the maximum cross-sectional area is ~4.7×3.9 cm); a soft-tissue mass was noted in the upper lobe of the left lung (size, ~11.7×8.6×9.6 cm), with a slightly higher FDG uptake. The lesion was involved the left hilum inwardly and the costal pleura in an outward direction; the upper lobe of the left lung nodule was noted in the tongue (~2.1 cm in diameter) and FDG uptake was mild. The left hilar demonstrated multiple lymph nodes (the larger diameter is ~2.5 cm) and FDG uptake was increased (red arrow). FDG, 18F-fluorodeoxyglucose.

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  Figure 6.. Histology of left lung biopsy tissue. (A) H&E staining (magnification, ×10). (B) H&E staining (magnification, ×40). The cells were arranged in an epithelioid or spindle-like shape and multinucleated tumor cells were observed (red arrow).