Pulmonary artery sarcoma masquerading as refractory pulmonary embolism in a 77-year-old man was initially treated with thrombectomy and embolectomy, but the patient expired after two months.
Case Report (n=1)
Pulmonary artery sarcoma can closely mimic thromboembolic disease and should be suspected in cases of persistent or worsening obstruction despite appropriate anticoagulation.
Abstract Introduction Pulmonary artery sarcoma (PAS) is a rare and aggressive malignancy that originates from the intimal layer of the pulmonary artery. PAS is frequently misdiagnosed, delaying appropriate treatment because its symptoms and imaging closely resemble acute or chronic pulmonary embolism (PE). Patients typically present with progressive dyspnea and chest discomfort, and filling defects on CT angiography are often attributed to thrombus. We report a case of pulmonary artery spindle cell sarcoma initially managed as recurrent PE despite compliant anticoagulation. Case A 77-year-old man with hypertension, hyperlipidemia, high-grade prostate cancer treated with radiation presented with one month of exertional dyspnea, pleuritic chest pain, and nonproductive cough. He denied recent surgery, prolonged immobility, personal or family history of venous thromboembolism. Ten days earlier he sought care for similar symptoms, and CTA showed right main and lobar artery pulmonary emboli. He was started on apixaban and discharged after normal cardiac biomarkers and echocardiography showed no right ventricular strain. Although initially improved, he returned because he developed severe dyspnea and palpitations while golfing. On exam he was hemodynamically stable without hypoxia and Laboratory findings unremarkable. Repeat CTA demonstrated the large right main and lobar pulmonary artery emboli from prior and a new obstruction of the left main pulmonary artery. He was transitioned to IV heparin, and repeat echocardiography showed right heart strain. Interventional Radiology performed mechanical thrombectomy with partial removal of the obstructing material. Due to continued right pulmonary artery occlusion, cardiothoracic surgery proceeded with right pulmonary artery embolectomy and thromboendarterectomy. The patient recovered uneventfully postoperatively, and was discharged on low-molecular-weight heparin on postoperative day seven. Histopathology of the embolic specimen revealed spindle cell sarcoma (intimal angiosarcoma) of the pulmonary artery and he was referred to specialized thoracic oncology. He returned to the ED a month after thrombectomy for worsening dyspnea where workup was without heart strain and he was discharged. Two weeks afterwards, he returned to the ED for syncopal episodes, suffered two cardiac arrests with one ROSC, and unfortunately he expired after the second arrest; approximately two months after his initial presentation. Conclusion This case highlights the diagnostic challenge of PAS, which closely mimics thromboembolic disease clinically and radiographically. Persistent or worsening obstruction despite appropriate anticoagulation should prompt suspicion of pulmonary vascular malignancy. Early tissue diagnosis is vital, as timely surgical intervention offers the best chance of survival, though overall prognosis remains poor. This abstract is funded by: None
Agudosi et al. (Fri,) conducted a case report in Pulmonary artery sarcoma (n=1). Mechanical thrombectomy and surgical embolectomy was evaluated. Pulmonary artery sarcoma masquerading as refractory pulmonary embolism in a 77-year-old man was initially treated with thrombectomy and embolectomy, but the patient expired after two months.
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