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Bourlond B, Maurizi N, Antiochos P, Skalidis I, Auf Der Springe K, Royer C, Monney P, Muller O, Kirsch M. Recurrence of an undifferentiated pleomorphic pulmonary artery sarcoma 8 years after initial presentation: a case report. Front Cardiovasc Med 2024; 11:1378333. [PMID: 38984354 PMCID: PMC11232353 DOI: 10.3389/fcvm.2024.1378333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/20/2024] [Indexed: 07/11/2024] Open
Abstract
Background Primary cardiac tumors remain exceptionally rare, characterized by a poor prognosis. Among them, sarcomas originating in the pulmonary arteries constitute the most infrequent subgroup within primary cardiac sarcomas. Case summary This report presents the case of a 76-year-old female experiencing a recurrence of an undifferentiated pleomorphic intracardiac pulmonary artery sarcoma located in the right ventricular outflow tract, manifesting 8 years after initial remission. Successful outcomes were attained through a combination of surgical resection, state-of-the-art radiotherapy, and chemotherapy. This comprehensive approach proved essential for optimizing both survival and quality of life. Discussion The unexpectedly prolonged recurrence-free survival observed in this case underscores the effectiveness of the comprehensive multimodal treatment approach outlined in the existing literature. This highlights the pivotal role of a multidisciplinary strategy in addressing primary cardiac sarcomas, particularly those arising in the pulmonary arteries.
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Affiliation(s)
- Baudouin Bourlond
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Niccolo Maurizi
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Panagiotis Antiochos
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Ioannis Skalidis
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Katarina Auf Der Springe
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claire Royer
- Department of Anatomopathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Mathias Kirsch
- Department of Anatomopathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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2
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Gao X, Xie A, Xiao W, Wei Z, Yu S. Pulmonary Artery Sarcoma Misdiagnosed as Pulmonary Embolism. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00375-6. [PMID: 38937171 DOI: 10.1053/j.jvca.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/23/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Xue Gao
- Guizhou Medical University, Guiyang, China; Department of Ultrasound Medicine, the First People's Hospital of Guiyang City, Guiyang, China
| | - Aihua Xie
- Department of Ultrasound Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Weiwei Xiao
- Guizhou Medical University, Guiyang, China; Department of Ultrasound Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhihong Wei
- Department of Ultrasound Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shaomei Yu
- Department of Ultrasound Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
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Liu Z, Fan L, Liang S, Wu Z, Huang H. A primary pulmonary artery sarcoma masquerading pulmonary embolism: a case report and literature review. Thromb J 2024; 22:4. [PMID: 38178144 PMCID: PMC10768095 DOI: 10.1186/s12959-023-00578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Primary pulmonary artery sarcoma (PAS) is an extremely rare malignant tumor with a poor prognosis. The clinical manifestations of PAS are diverse, including dyspnea, chest pain, cough, and hemoptysis. The poor prognosis is often due to delayed diagnosis caused by similarity in imaging findings with pulmonary thromboembolism (PTE). These cues of diagnosis include the "wall eclipsing sign", lobulated bulging margins, gadolinium enhancement during MRI imaging, and FDG uptake during PET/CT imaging. However, there are still many misdiagnoses. CASE PRESENTATION This article reports a woman of reproductive age presenting with a pulmonary artery mass. The computed tomographic pulmonary angiography and positron emission tomography/computed tomography did not show obvious signs of pulmonary artery sarcoma, however, contrast-enhanced echocardiography showed moderate perfusion, which helped differentiate between pulmonary artery sarcoma and pulmonary artery thrombosis, leading to timely surgical treatment. CONCLUSIONS PAS is a rare form of cancer that can occasionally be visually similar to PTE on radiographic images. Early diagnosis of PAS is of vital importance to the prognosis of the patients. There are several visual cues that can help differentiate between the two conditions. Additionally, contrast-enhanced echocardiography provides additional information on tumor perfusion, offering another effective approach for a prompt and accurate diagnosis.
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Affiliation(s)
- Zhiyue Liu
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Alley, Chengdu, 610041, China
| | - Lili Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Alley, Chengdu, 610041, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Alley, Chengdu, 610041, China.
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Alley, Chengdu, 610041, China.
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4
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Elhage Hassan M, Vinales J, Perkins S, Sandesara P, Aggarwal V, Jaber WA. Pathogenesis, Diagnosis, and Management of Chronic Thromboembolic Pulmonary Hypertension. Interv Cardiol Clin 2023; 12:e37-e49. [PMID: 38964822 DOI: 10.1016/j.iccl.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to occur as a sequelae of thromboembolic processes in the pulmonary vasculature. The pathophysiology of CTEPH is multifactorial, including impaired fibrinolysis, endothelial dysregulation, and hypoxic adaptations. The diagnosis of CTEPH is typically delayed considering the nonspecific nature of the symptoms, lack of screening, and relatively low incidence. Diagnostic tools include ventilation-perfusion testing, echocardiography, cardiac catheterization, and pulmonary angiography. The only potentially curative treatment for CTEPH is pulmonary endarterectomy However, approximately 40% of patients are inoperable. Currently, only Riociguat is Food and Drug Administration approved specifically for CTEPH, with additional drug trials underway.
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Affiliation(s)
- Malika Elhage Hassan
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road Northeast Suite F606, Atlanta, GA 30322, USA
| | - Jorge Vinales
- Department of Medicine, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA
| | - Sidney Perkins
- Department of Internal Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Pratik Sandesara
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road Northeast Suite F606, Atlanta, GA 30322, USA
| | - Vikas Aggarwal
- Department of Cardiology, Henry Ford Medical Center, 2799 W Grand Blvd, K-2 Cath Admin Suite, Detroit, MI 48206, USA
| | - Wissam A Jaber
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road Northeast Suite F606, Atlanta, GA 30322, USA.
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5
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Catalano M, Crimi L, Galioto F, Coronella M, Foti PV, Palmucci S, Basile A. Not always embolism: A case of pulmonary artery intimal sarcoma - The role of the radiologist in early diagnosis. Respir Med Case Rep 2023; 42:101822. [PMID: 36874264 PMCID: PMC9975687 DOI: 10.1016/j.rmcr.2023.101822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Pulmonary artery intimal sarcoma (PAIS) is a rare malignant neoplasm with imaging features that can mimic pulmonary embolism (PE). It must be recognized early because a radical resection may be useful to prolong survival. Case description A clinical case of a 57-year-old Caucasian male affected by PAIS is presented, which describes the computed tomography (CT) findings found in PAIS and the elements of overlap and differentiation with PE. The main common element is represented by the endoluminal filling defect of the pulmonary arterial vessels in contrast-enhanced CT examinations; a characteristic polypoid morphology or polylobulated contours are typical findings of PAIS. Other specific elements of the neoplasm such as wall eclipse sign, extension beyond the arterial wall, and metastasis are also explained. Conclusions The overlap of the clinical-radiological findings and the epidemiological difference between PAIS and PE cause a diagnostic delay. By knowing the differential elements, the radiologist can detect the neoplasm early to accelerate diagnosis and suggest optimal management.
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Affiliation(s)
- Marco Catalano
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, 95123, Italy
| | - Luca Crimi
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, 95123, Italy
| | - Federica Galioto
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, 95123, Italy
| | - Maria Coronella
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, 95123, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, 95123, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, 95123, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, 95123, Italy
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6
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Chan EY, Ravi V, Ali A, Nguyen DT, Graviss EA, MacGillivray TE, Reardon MJ. Surgical Management of Primary Pulmonary Artery Sarcoma. Semin Thorac Cardiovasc Surg 2023; 35:53-64. [PMID: 34743005 DOI: 10.1053/j.semtcvs.2021.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/11/2022]
Abstract
Primary pulmonary artery sarcoma is a rare cardiac tumor with a dismal prognosis without surgical therapy. It is often confused with the more common chronic pulmonary emboli which may delay the appropriate diagnosis or lead to suboptimal surgery. The objective of this study was to evaluate the short and long-term survival and local recurrence rate of pulmonary artery sarcoma cases operated on at our institution using an anatomic resection approach for the pulmonary trunk and main pulmonary arteries rather than endarterectomy. We searched our prospectively collected cardiac tumor database for cases of primary pulmonary sarcoma operated at our institution between June 2000 and September 2018 and followed until January 3, 2021. We used an anatomic resection and replacement technique for involved pulmonary root and main pulmonary arteries with endarterectomy used only for disease distal to the first arterial branch when lung preservation was possible. The primary endpoints for our study were survival from the time of initial diagnosis and survival from the time of our surgery. Secondary endpoints were operative 30-day mortality and incidence of local recurrence or metastatic disease. We identified 20 consecutive cases of surgical resection of primary pulmonary sarcoma. The median age at surgery was 52.5 years (IQR 43.5-60.5). Complete pulmonary root resection and reconstruction using a pulmonary homograft were needed in 16/20 (80%) of cases. All resections employed cardiopulmonary bypass with cardioplegic arrest. A pneumonectomy was needed in 7/20 (35%) of patients. A negative margin (R0) resection was achieved in 9 patients (45%) and margins were microscopically positive (R1) on final pathology in 9 patients (45%). Two patients (10%) had gross tumor (R2) at the resection margin. Operative mortality was 2/20 (10%). Median survival was 2.8 years from diagnosis (95% CI 1.3-8.8) and 2.7 years from surgery by our team (95% CI 0.8-5.9). Survival from first initial diagnosis at 1, 3, 5, and 10 years was 85.0%, 49.1%, 49.1%, and 16.4%. Survival from our surgery by our team at 1, 3, 5, and 10 years was 70%, 48.8%, 41.8%, and 8.4%. Surgical resection of primary pulmonary artery sarcoma with an approach utilizing an anatomic resection of the pulmonary root and main pulmonary arteries when involved and pneumonectomy or endarterectomy when there is disease distal to the first branch artery can be done with a reasonable operative risk and long-term survival when compared to the natural history of the disease.
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Affiliation(s)
- Edward Y Chan
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Vinod Ravi
- Department of Sarcoma Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Areeba Ali
- Houston Methodist Research Institute, Houston, Texas
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas
| | | | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas.
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7
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Lashari BH, Kumaran M, Aneja A, Bull T, Rali P. Beyond Clots in the Pulmonary Circulation: Pulmonary Artery Tumors Mimicking Pulmonary Embolism. Chest 2022; 161:1642-1650. [PMID: 35041833 DOI: 10.1016/j.chest.2022.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/02/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022] Open
Abstract
Pulmonary embolism (PE) is the most common filling defect seen on CT scan pulmonary angiography. Pulmonary artery (PA) tumors can mimic PE on imaging and clinical presentation. One classic feature of tumors is failure to improve on anticoagulation. PA tumors, particularly malignant ones, have radically different treatments and usually have a grim prognosis. Thus, it is essential that PA tumors, when suspected, receive an expedited confirmatory diagnosis followed by multidisciplinary treatment at an expert center. In this review, we present clinical, imaging, and histopathologic features of benign and malignant PA tumors, emphasizing differentiating features from PE. We also describe available diagnostic and treatment methods for PA tumors.
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Affiliation(s)
- Bilal Haider Lashari
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA.
| | - Maruti Kumaran
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Amandeep Aneja
- Department of Pathology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Todd Bull
- Department of Medicine, Pulmonary Sciences and Critical Care, University of Colorado, Aurora, CO
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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8
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Espinola-Zavaleta N, Fernández-Badillo V, Solorzano-Pinot E. New approach of contrast echocardiography: differential diagnosis between pulmonary thrombi and tumors in the pulmonary arteries. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:823-824. [PMID: 34689248 DOI: 10.1007/s10554-021-02453-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nilda Espinola-Zavaleta
- Department of Nuclear Medicine, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico City, Mexico.
- Department of Echocardiography, ABC Medical Center, I.A.P., Mexico City, Mexico.
| | - Valente Fernández-Badillo
- Department of Nuclear Medicine, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Enrique Solorzano-Pinot
- Department of Nuclear Medicine, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico City, Mexico
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9
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Hassler KR, Puig CA, Cangut B, Pochettino A, Robinson SI, Morris JM, Blackmon SH. Pulmonary Artery Sarcoma Complete Resection Facilitated by Three-Dimensional Printed Model. Ann Thorac Surg 2022; 114:e375-e378. [PMID: 35051392 DOI: 10.1016/j.athoracsur.2021.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/01/2022]
Abstract
Primary pulmonary (PA) artery sarcomas are rare tumors and are commonly misdiagnosed as pulmonary embolism. PA sarcomas demonstrate intraluminal growth into the vessel rather than through the wall, require complete resection to enhance survival, and require complex surgical planning. The purpose of this case report is to describe an optimal team approach with multidisciplinary planning facilitated by a customized three-dimensional (3D) model to guide intervention and enhance communication.
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Affiliation(s)
| | - Carlos A Puig
- Department of Thoracic Surgery, Mayo Clinic, Rochester, MN
| | - Busra Cangut
- Department of Cardiac Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Jonathan M Morris
- Department of Radiology and the Anatomic Modeling Lab, Mayo Clinic, Rochester, MN
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10
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Sharma MS. Commentary: Pulmonary artery sarcoma-an invitation to the masquerade ball. JTCVS Tech 2021; 10:315-316. [PMID: 34984393 PMCID: PMC8691909 DOI: 10.1016/j.xjtc.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mahesh S. Sharma
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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11
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Ravi V, Reardon MJ. Commentary: Taking to heart the challenge of primary cardiac sarcoma. JTCVS OPEN 2021; 8:391-392. [PMID: 36004075 PMCID: PMC9390430 DOI: 10.1016/j.xjon.2021.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 11/17/2022]
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12
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Reardon MJ. Commentary: Opportunity is like a sunrise. If you wait too long, you miss it. JTCVS Tech 2021; 10:313-314. [PMID: 34984392 PMCID: PMC8691904 DOI: 10.1016/j.xjtc.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022] Open
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13
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Malik MI, Rabbani M, Hage F, Inculet R, Chu MW. Missed pulmonary artery sarcoma requiring radical excision and pneumonectomy. JTCVS Tech 2021; 10:309-312. [PMID: 34984391 PMCID: PMC8691900 DOI: 10.1016/j.xjtc.2021.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mohsyn Imran Malik
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Mohamad Rabbani
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Fadi Hage
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Richard Inculet
- Division of Thoracic Surgery, Western University, London, Ontario, Canada
- Division of Oncology, Western University, London, Ontario, Canada
| | - Michael W.A. Chu
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
- Address for reprints: Michael W. A. Chu, MD, MEd, London Health Sciences Centre, B6-106 University Hospital, 339 Windermere Rd, London, Ontario, Canada N6A 5A5.
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14
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Espinola-Zavaleta N, Fernández-Badillo V, Solorzano-Pinot E. New approach of contrast echocardiography: differential diagnosis between pulmonary thrombi and tumors in the pulmonary arteries. Int J Cardiovasc Imaging 2021; 38:159-160. [PMID: 34657231 DOI: 10.1007/s10554-021-02447-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Nilda Espinola-Zavaleta
- Department of Nuclear Medicine, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, P.C. 14080, Mexico City, Mexico. .,Department of Echocardiography, ABC Medical Center, I.A.P, Mexico City, Mexico.
| | - Valente Fernández-Badillo
- Department of Nuclear Medicine, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, P.C. 14080, Mexico City, Mexico
| | - Enrique Solorzano-Pinot
- Department of Nuclear Medicine, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, P.C. 14080, Mexico City, Mexico
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15
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Bai X, Ruan L. A case report of primary pulmonary artery intimal sarcoma. Eur J Med Res 2021; 26:89. [PMID: 34372932 PMCID: PMC8351160 DOI: 10.1186/s40001-021-00568-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background Pulmonary artery intimal sarcoma (PAS) is a very rare disease, its prevalence is about 0.001–0.003%. PAS is often misdiagnosed as acute or chronic pulmonary thromboembolism due to its clinical presentation and radiological findings. Thus, early diagnosis is very crucial and may improve patient outcome. Case presentation Here, we report a case in a Chinese male where the symptom presentation was episodes of shortness of breath. Transthoracic echocardiography showed a solid mass in the pulmonary valve orifice, which was demonstrated to be a pulmonary artery intimal sarcoma diagnosed by histopathology. In this case, the initial differential diagnosis included pulmonary embolism. Because the initial symptom of primary pulmonary artery sarcoma is extremely similar to the pulmonary embolism, half of them may be misdiagnosed as pulmonary embolism. Imaging studies are very helpful. Ultrasound and CT are the best due to their resolution and ability to assess the relationship of the mass with the surrounding structures. The final diagnosis is mostly made after surgical excision and this is the most effective treatment. At the same time, radiotherapy and chemotherapy after surgery is also an adjuvant treatment. Conclusion We report a very rare case of pulmonary artery intimal sarcoma. Due to late diagnosis and delayed treatment in this case, the patient displayed a poor prognostic. Early diagnosis and right treatment can improve the prognosis of PAS and optimize overall health.
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Affiliation(s)
- Xiaofang Bai
- The Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Litao Ruan
- The Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, China.
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16
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Martínez-Trufero J, Cruz Jurado J, Gómez-Mateo MC, Bernabeu D, Floría LJ, Lavernia J, Sebio A, García Del Muro X, Álvarez R, Correa R, Hernández-León CN, Marquina G, Hindi N, Redondo A, Martínez V, Asencio JM, Mata C, Valverde Morales CM, Martin-Broto J. Uncommon and peculiar soft tissue sarcomas: Multidisciplinary review and practical recommendations for diagnosis and treatment. Spanish group for Sarcoma research (GEIS - GROUP). Part I. Cancer Treat Rev 2021; 99:102259. [PMID: 34311246 DOI: 10.1016/j.ctrv.2021.102259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/22/2022]
Affiliation(s)
| | - Josefina Cruz Jurado
- Hospital Universitario Canarias, Medical Oncology Department, Santa Cruz de Tenerife, Spain
| | | | - Daniel Bernabeu
- Hospital Universitario La Paz, Radiology Department, Madrid, Spain
| | - Luis Javier Floría
- Hospital Universitario Miguel Servet, Orthopedic and Traumatology Department, Zaragoza, Spain
| | - Javier Lavernia
- Instituto Valenciano de Oncología, Medical Oncology Department, Valencia, Spain
| | - Ana Sebio
- Hospital Universitario Santa Creu i Sant Pau, Medical Oncology Department, Barcelona, Spain
| | | | - Rosa Álvarez
- Hospital Universitario Gregorio Marañón, Medical Oncology Department, Madrid, Spain
| | - Raquel Correa
- Hospital Virgen de la Victoria, Radiation Oncology Department, Malaga, Spain
| | | | - Gloria Marquina
- Hospital Universitario Clínico San Carlos, Medical Oncology Department, Madrid, Spain
| | - Nadia Hindi
- University Hospital "Fundacion Jimenez Diaz" Madrid, Medical Oncology Department, Madrid, Research Institute FJD-UAM, Madrid (Spain), TBsarc, CITIUS III, Seville, Spain
| | - Andrés Redondo
- Hospital Universitario La Paz, Medical Oncology Department, Madrid, Spain
| | - Virginia Martínez
- Hospital Universitario La Paz, Medical Oncology Department, Madrid, Spain
| | | | - Cristina Mata
- Hospital Universitario Gregorio Marañón, Pediatric and Adolescent Hemato-oncology Department, Madrid, Spain
| | | | - Javier Martin-Broto
- University Hospital "Fundacion Jimenez Diaz" Madrid, Medical Oncology Department, Madrid, Research Institute FJD-UAM, Madrid (Spain), TBsarc, CITIUS III, Seville, Spain
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17
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Li X, Hong L, Huo XY. Undifferentiated intimal sarcoma of the pulmonary artery: A case report. World J Clin Cases 2021; 9:3960-3965. [PMID: 34141753 PMCID: PMC8180227 DOI: 10.12998/wjcc.v9.i16.3960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/16/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Since 1923, only a few hundred cases of pulmonary arterial sarcoma (PAS) have been reported. It is easy for PAS to be misdiagnosed as pulmonary thromboembolism, which makes treatment difficult. The median survival time without surgical treatment for PAS is only 1.5-3 mo. Echocardiography is widely used in screening for pulmonary artery space-occupying lesions in patients with chest pain, dyspnea, and cough; furthermore, it is typically considered the first imaging examination for patients with PAS.
CASE SUMMARY In May 2017, a 39-year-old male patient experienced chest pain with no particular obvious cause. At that time, the cause was thought to be pulmonary embolism. In July 2017, positron emission tomography–computed tomography revealed space-occupying lesions in the right lung and multiple metastases in both lungs. The lesions of the right lung were biopsied, and pathology revealed undifferentiated sarcoma. Chemotherapy had been performed since July 2017 in another hospital. In December 2019, the patient was admitted to our hospital for the sake of CyberKnife treatment. Echocardiography suggested: (1) A right ventricular outflow tract (RVOT) solid mass of the main pulmonary artery; and (2) mild pulmonary valve regurgitation. Ultrasonography showed the absence of a thrombus in the deep veins of either lower limb.
CONCLUSION PAS is a single, central space-occupying lesion involving the RVOT and pulmonary valve. Echocardiography of PAS has its own characteristics.
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Affiliation(s)
- Xin Li
- Department of Ultrasonography, Chinese People's Liberation Army General Hospital-Sixth Medical Center, Beijing 100048, China
| | - Liu Hong
- Department of Ultrasonography, Chinese People's Liberation Army General Hospital-Sixth Medical Center, Beijing 100048, China
| | - Xiao-Yan Huo
- Department of Ultrasonography, Chinese People's Liberation Army General Hospital-Sixth Medical Center, Beijing 100048, China
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18
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Altshuler E, Lowther G, Jantz M. Primary Pulmonary Artery Sarcoma Confined to the Left Pulmonary Artery. J Investig Med High Impact Case Rep 2021; 9:23247096211014687. [PMID: 33969719 PMCID: PMC8113362 DOI: 10.1177/23247096211014687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Primary pulmonary artery sarcomas (PPAS) are extremely rare tumors that are often mislabeled as pulmonary emboli (PE). PPAS usually involve the pulmonary trunk and are histologically classified as leiomyosarcoma, spindle cells sarcoma, fibrous histiocytoma, or undifferentiated sarcoma. Our case involved a 78-year-old man with an undifferentiated PPAS confined to the left pulmonary artery that was initially misdiagnosed as a PE. After a month-long delay in treatment in which the patient was prescribed warfarin, the correct diagnosis was made. Pulmonary artery endarterectomy and left lung pneumonectomy were performed, and he survived for 18 months before disease recurrence and death. Our case helps illustrate some of the clinical and radiographic findings that help distinguish PPAS from PE.
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19
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Ropp AM, Burke AP, Kligerman SJ, Leb JS, Frazier AA. Intimal Sarcoma of the Great Vessels. Radiographics 2021; 41:361-379. [PMID: 33646906 DOI: 10.1148/rg.2021200184] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Intimal sarcomas of the pulmonary artery and aorta are rare entities with a poor prognosis. In many instances, pulmonary artery sarcomas are misinterpreted as acute or chronic pulmonary thromboembolism, whereas aortic intimal sarcomas are often misdiagnosed as protuberant atherosclerotic disease or intimal thrombus. Discernment of intimal sarcomas from these and other common benign entities is essential for the timely initiation of aggressive therapy. The most useful imaging modalities for assessment of a suspected intimal sarcoma include CT angiography, fluorine 18-fluorodeoxyglucose PET, and MRI. The authors discuss the clinical features, current treatment options, characteristic imaging findings, and underlying pathologic features of intimal sarcomas. The authors emphasize imaging discernment of intimal sarcomas and how their differential diagnosis is informed by knowledge of radiologic-pathologic correlation. The most reliable distinguishing imaging features are also emphasized to improve accurate and timely diagnosis. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Alan M Ropp
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903 (A.M.R.); Departments of Pathology (A.P.B.) and Diagnostic Radiology and Nuclear Medicine (A.A.F.), University of Maryland School of Medicine, Baltimore, Md; Department of Diagnostic Radiology, University of California San Diego School of Medicine, San Diego, Calif (S.J.K.); Department of Diagnostic Radiology, Columbia University Medical Center, New York, NY (J.S.L.); and American Institute for Radiologic Pathology Program (AIRP), American College of Radiology, Silver Spring, Md, and Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Md (A.A.F.)
| | - Allen P Burke
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903 (A.M.R.); Departments of Pathology (A.P.B.) and Diagnostic Radiology and Nuclear Medicine (A.A.F.), University of Maryland School of Medicine, Baltimore, Md; Department of Diagnostic Radiology, University of California San Diego School of Medicine, San Diego, Calif (S.J.K.); Department of Diagnostic Radiology, Columbia University Medical Center, New York, NY (J.S.L.); and American Institute for Radiologic Pathology Program (AIRP), American College of Radiology, Silver Spring, Md, and Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Md (A.A.F.)
| | - Seth J Kligerman
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903 (A.M.R.); Departments of Pathology (A.P.B.) and Diagnostic Radiology and Nuclear Medicine (A.A.F.), University of Maryland School of Medicine, Baltimore, Md; Department of Diagnostic Radiology, University of California San Diego School of Medicine, San Diego, Calif (S.J.K.); Department of Diagnostic Radiology, Columbia University Medical Center, New York, NY (J.S.L.); and American Institute for Radiologic Pathology Program (AIRP), American College of Radiology, Silver Spring, Md, and Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Md (A.A.F.)
| | - Jay S Leb
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903 (A.M.R.); Departments of Pathology (A.P.B.) and Diagnostic Radiology and Nuclear Medicine (A.A.F.), University of Maryland School of Medicine, Baltimore, Md; Department of Diagnostic Radiology, University of California San Diego School of Medicine, San Diego, Calif (S.J.K.); Department of Diagnostic Radiology, Columbia University Medical Center, New York, NY (J.S.L.); and American Institute for Radiologic Pathology Program (AIRP), American College of Radiology, Silver Spring, Md, and Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Md (A.A.F.)
| | - Aletta A Frazier
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903 (A.M.R.); Departments of Pathology (A.P.B.) and Diagnostic Radiology and Nuclear Medicine (A.A.F.), University of Maryland School of Medicine, Baltimore, Md; Department of Diagnostic Radiology, University of California San Diego School of Medicine, San Diego, Calif (S.J.K.); Department of Diagnostic Radiology, Columbia University Medical Center, New York, NY (J.S.L.); and American Institute for Radiologic Pathology Program (AIRP), American College of Radiology, Silver Spring, Md, and Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Md (A.A.F.)
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20
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Massie E, White M, Robillard J, Demers P, Mondésert B, Doyon J, Chaix MA. Palpitations Revealing a Primary Pulmonary Artery Sarcoma. CJC Open 2021; 3:831-834. [PMID: 34169263 PMCID: PMC8209369 DOI: 10.1016/j.cjco.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022] Open
Abstract
Primary pulmonary artery sarcoma is an exceedingly rare and aggressive malignancy that carries poor prognosis. Clinical manifestations are nonspecific and include chest pain, dyspnea, syncope, palpitations, and asthenia, among others. Delay to diagnosis is common and compromises the prognosis. Here, we report an interesting case of primary pulmonary artery sarcoma presenting with frequent monomorphic premature ventricular contractions arising from the right/left ventricle outflow tract. Cardiac imaging is key in the evaluation of patients with frequent premature ventricular contractions to rule out rare pathologies such as tumour compression.
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Affiliation(s)
- Emmanuelle Massie
- Department of Medicine, Division of Cardiology, Montreal Heart institute, Université de Montréal, Montréal, Québec, Canada
| | - Michel White
- Department of Medicine, Division of Cardiology, Montreal Heart institute, Université de Montréal, Montréal, Québec, Canada
| | - Julie Robillard
- Department of Medicine, Division of Radiology, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Demers
- Department of Medicine, Division of Surgery, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Blandine Mondésert
- Department of Medicine, Division of Cardiology, Montreal Heart institute, Université de Montréal, Montréal, Québec, Canada
| | - Josée Doyon
- Department of Medicine, Division of Pathology, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Québec, Canada
| | - Marie-A Chaix
- Department of Medicine, Division of Cardiology, Montreal Heart institute, Université de Montréal, Montréal, Québec, Canada
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21
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Zhang S, Zhang Y, Liu M, Tao X, Xie W, Wan J, Zhai Z. Radiological, histopathological findings, and clinical outcome of pulmonary artery sarcoma. Pulm Circ 2021; 11:2045894020940537. [PMID: 33456752 PMCID: PMC7797598 DOI: 10.1177/2045894020940537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022] Open
Abstract
Pulmonary artery sarcoma is a rare malignancy with poor prognosis. Lack of specific clinical manifestations, some patients are even confirmed postoperatively or at autopsy, that leads to the delay in treatment. Early diagnosis and radical surgical resection provide the possibility of prolonged survival. We retrospectively enrolled 13 patients diagnosed with pulmonary artery sarcoma at our hospital between 2015 and 2019. Their clinical, laboratory, radiological, and histopathological data were collected and analyzed. Published case series were also reviewed. Results show that, the median age of the patients was 53 years, with 6 (46.2%) males. The most common symptom is exertional dyspnea. Erythrocyte sedimentation rate and C-reactive protein were increased in 76.9% and 69.2% of these patients, while D-Dimer remained normal or elevated slightly. Metastasis was present at diagnosis in eight (61.5%) patients. Ten patients were diagnosed histologically: three were diagnosed after pulmonary endarterectomy, four by endobronchial ultrasound-guided transbronchial needle aspiration, two by percutaneous lung biopsy, and one by endovascular aspiration biopsy. Four patients underwent surgery and one is waiting for surgery. Nine patients received chemotherapy; and three of them received targeted therapy with anlotinib after chemotherapy. Two patients received anti-PD-1 monoclonal antibody. One patient died during endobronchial ultrasound-guided transbronchial needle aspiration. Two patients died 9 and 13 months after diagnosis, respectively; one refused invasive diagnostic procedures and died three months after clinical diagnosis. In conclusion, the most appropriate approach to get tissue specimen needs to be tailored to every pulmonary artery sarcoma patient. Pulmonary endarterectomy combined with chemotherapy and targeted therapy has prolonged their survival time.
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Affiliation(s)
- Shuai Zhang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Yu Zhang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Capital Medical University, Beijing, China
| | - Min Liu
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Xincao Tao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Wanmu Xie
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Jun Wan
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
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22
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Matusov Y, Singh I, Yu YR, Chun HJ, Maron BA, Tapson VF, Lewis MI, Rajagopal S. Chronic Thromboembolic Pulmonary Hypertension: the Bedside. Curr Cardiol Rep 2021; 23:147. [PMID: 34410530 PMCID: PMC8375459 DOI: 10.1007/s11886-021-01573-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Chronic thromboembolic pulmonary hypertension (CTEPH), included in group 4 PH, is an uncommon complication of acute pulmonary embolism (PE), in which emboli in the pulmonary vasculature do not resolve but rather form into an organized scar-like obstruction which can result in right ventricular (RV) failure. Here we provide an overview of current diagnosis and management of CTEPH. RECENT FINDINGS CTEPH management is complex with treatments that range from surgery, percutaneous interventions, to medical therapies. Current CTEPH medical therapies have largely been repurposed from pulmonary arterial hypertension (PAH). The diagnosis of CTEPH can be challenging, requiring a multimodality approach to differentiate from disease mimics. While these treatments improve symptoms, they may not reverse the underlying pathology of CTEPH.
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Affiliation(s)
- Yuri Matusov
- grid.50956.3f0000 0001 2152 9905Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Inderjit Singh
- grid.47100.320000000419368710Division of Pulmonary, Critical Care, and Sleep Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT USA
| | - Yen-Rei Yu
- grid.189509.c0000000100241216Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, NC USA
| | - Hyung J. Chun
- grid.47100.320000000419368710Section of Cardiovascular Medicine, Department of Internal Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT USA
| | - Bradley A. Maron
- grid.410370.10000 0004 4657 1992Section of Cardiology, Veterans Affairs Boston Healthcare System, Boston, MA USA ,grid.62560.370000 0004 0378 8294Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Victor F. Tapson
- grid.50956.3f0000 0001 2152 9905Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Michael I. Lewis
- grid.50956.3f0000 0001 2152 9905Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Sudarshan Rajagopal
- grid.189509.c0000000100241216Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC USA
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23
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Han Y, Zhen Y, Liu X, Zheng X, Zhang J, Zhai Z, Duan J, Zhang Y, Liu P. Surgical treatment of primary pulmonary artery sarcoma. Gen Thorac Cardiovasc Surg 2020; 69:638-645. [PMID: 32918676 PMCID: PMC7981312 DOI: 10.1007/s11748-020-01476-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/27/2020] [Indexed: 10/29/2022]
Abstract
OBJECTIVE Primary pulmonary artery sarcoma (PAS) is a rare tumor that originates from the intimal layer of the pulmonary artery or pulmonary valve and has a poor prognosis. The standard treatment for this devastating disease remains unclear. This study aimed to summarize the current standard treatments for PAS. METHODS From September 2015 to January 2020, six patients were diagnosed with PAS and underwent pulmonary endarterectomy (PEA) at our department. Their medical records were retrospectively reviewed to analyze the clinical characteristics, histopathological features, and postoperative outcomes. Fourteen articles, each reporting at least 6 cases, identified 201 patients diagnosed with PAS, and 158 patients had detailed treatments and follow-up data. RESULTS All of the patients who successfully underwent PEA were alive at follow-up, with a mean survival duration of 11.6 months (7-28 months), and one patient developed recurrence in the right upper lobe lung. Two patients received postoperative chemotherapy. In one patient, the tumor invaded the pulmonary valve. CONCLUSIONS PAS resection combined with PEA via the aid of cardiopulmonary bypass and deep hypothermic circulatory arrest could achieve maximal tumor resection in patients without metastatic lesions. An individualized surgery strategy relies on a precise preoperative imaging examination. Moreover, postoperative adjuvant therapy could yield improved survival outcomes.
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Affiliation(s)
- Yongxin Han
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, China
| | - Yanan Zhen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Cherry Park East Street, Chaoyang District, Beijing, 100029, China
| | - Xiaopeng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Cherry Park East Street, Chaoyang District, Beijing, 100029, China
| | - Xia Zheng
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Cherry Park East Street, Chaoyang District, Beijing, 100029, China
| | - Jianbin Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Cherry Park East Street, Chaoyang District, Beijing, 100029, China
| | - Zhenguo Zhai
- Respiratory Department, China-Japan Friendship Hospital, Beijing, China
| | - Jun Duan
- Surgical Intensive Care Unit, China-Japan Friendship Hospital, Beijing, China
| | - Yajun Zhang
- Surgical Anesthesia Department, China-Japan Friendship Hospital, Beijing, China
| | - Peng Liu
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, China. .,Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Cherry Park East Street, Chaoyang District, Beijing, 100029, China.
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24
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Su H, Wei R, Duan Y, Guo Z, Wang A, Jiang N, Li W, Zhu Y, Guo Y, Zhang M, Zhang Y, Cao Y. A rare case of severe right heart failure due to pulmonary artery lymphomatoid granulomatosis. ESC Heart Fail 2020; 7:4343-4347. [PMID: 32964628 PMCID: PMC7754766 DOI: 10.1002/ehf2.13000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 11/09/2022] Open
Abstract
Lymphomatoid granulomatosis is a rare, vascular-centric, and vessel-destroying lymphoproliferative disease that hardly involves the pulmonary arteries. Herein, we report a case with severe right heart failure and pulmonary arterial stenosis caused by pulmonary artery lymphomatoid granulomatosis. This case was diagnosed by percutaneous transluminal pulmonary artery biopsy and was effectively treated with stent implantation and steroid administration.
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Affiliation(s)
- Hongling Su
- The Department of Cardiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Rong Wei
- The Department of Cardiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Yichao Duan
- Clinical Medicine School, Ningxia Medical University, Yinchuan, 750004, China
| | - Zhaoxia Guo
- The Department of Cardiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Aqian Wang
- The Department of Cardiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Na Jiang
- The Department of Cardiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Wanpeng Li
- The Department of Cardiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Yan Zhu
- The Department of Cardiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Yanqing Guo
- The Department of Cardiology, Shanxi Cardiovascular Hospital Affiliated with Shanxi Medical University, Taiyuan, 030024, China
| | - Min Zhang
- The Department of Pathology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Yan Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Yunshan Cao
- The Department of Cardiology, Gansu Provincial Hospital, Lanzhou, 730000, China.,The Department of Cardiology, Shanxi Cardiovascular Hospital Affiliated with Shanxi Medical University, Taiyuan, 030024, China
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25
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Cardiovascular imaging 2019 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2020; 36:769-787. [PMID: 32281010 DOI: 10.1007/s10554-020-01845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Xu R, Zhao Y, Xu X, Liu S, Hu C, Lv D, Wu H. Pulmonary intimal sarcoma involving the pulmonary valve and right ventricular outflow tract: A case report and literature review. Medicine (Baltimore) 2020; 99:e18813. [PMID: 32011489 PMCID: PMC7220449 DOI: 10.1097/md.0000000000018813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Pulmonary artery intimal sarcoma (PAIS) is a rare and highly aggressive tumor, and approximately 80% of pulmonary cases occur in the pulmonary trunk. We report herein a case of retrograde extension of the sarcoma to the pulmonary valve and right ventricle, which is an uncommon manifestation of this lethal tumor. PATIENT CONCERNS A 41-year-old woman was initially diagnosed with pulmonary thromboembolism (PTE) and transferred to our hospital. DIAGNOSIS Computed tomographic pulmonary angiography (CTPA) showed that there are low-density filling defects in both pulmonary arteries, and the patient was diagnosed with PTE. However, the ultrasonographers considered that the lesion is a space-occupying type that involves the right ventricular outflow tract and pulmonary valve instead of PTE. Postoperative pathology confirmed the diagnosis of PAIS. INTERVENTIONS The patient underwent resection of pulmonary artery sarcoma and endarterectomy. OUTCOMES During the follow-up via telephone 1 month after discharge, the patient reported to have been feeling well. CONCLUSION Owing to the rarity of the disease and its non-specific clinical manifestations, approximately half of the PAIS cases are misdiagnosed or have a delayed diagnosis. Thus, improving our understanding of the disease and facilitating its early diagnosis are essential.
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Affiliation(s)
- Rui Xu
- Department of Ultrasonography, Second Hospital of Jilin University
| | - Yixuan Zhao
- Department of Ultrasonography, Second Hospital of Jilin University
| | - Xiaosen Xu
- Department of Ultrasonography, Changchun Traditional Chinese, Medicine Hospital, Changchun, Jilin, China
| | - Shuang Liu
- Department of Ultrasonography, Second Hospital of Jilin University
| | - Chenyu Hu
- Department of Ultrasonography, Second Hospital of Jilin University
| | - Dongmei Lv
- Department of Ultrasonography, Second Hospital of Jilin University
| | - Huiying Wu
- Department of Ultrasonography, Second Hospital of Jilin University
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27
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Al-Mehisen R, Al-Halees Z, Alnemri K, Al-Hemayed W, Al-Mohaissen M. Primary pulmonary artery sarcoma: A rare and overlooked differential diagnosis of pulmonary embolism. Clues to diagnosis. Int J Surg Case Rep 2019; 65:15-19. [PMID: 31675686 PMCID: PMC6838465 DOI: 10.1016/j.ijscr.2019.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/05/2019] [Accepted: 10/08/2019] [Indexed: 12/31/2022] Open
Abstract
PPAS is an aggressive malignant tumor that masquerades as PE leading to a delay in diagnosis. Limited data exist on the clinical presentation, diagnosis, and management of PPAS. Knowledge of the clinical and imaging characteristics of this tumor is of importance for clinicians and surgeons. Early definitive surgery may improve survival; early diagnosis aided by imaging studies improves surgical outcomes.
Introduction Primary pulmonary artery sarcoma (PPAS) is a very rare tumor that mimics pulmonary embolism (PE) in clinical presentation and on imaging studies, therefore leading to diagnostic delay and increased patient mortality. Presentation of case We discuss the case of 37-year-old man with a rapidly progressing PPAS, which was initially managed as PE. Imaging studies, particularly computed tomography and magnetic resonance imaging, were helpful in reaching the correct diagnosis. Because of the dismal prognosis of such cases, which improves by definite surgery, the patient underwent extensive surgical resection which got complicated by pulmonary reperfusion injury and intrapulmonary hemorrhage, and thus died. Discussion Owing to the rarity of the tumor, PPAS is often initially mistakenly diagnosed as PE, leading to a diagnostic delay and increased mortality. Having a high index of suspicion in “atypical PE” cases and a knowledge of the characteristic radiological and clinical features of PPAS may expedite the diagnosis and improve survival. Pulmonary artery distension by the mass on imaging studies and compression of neighboring structures are in favor of a tumor rather than PE. Additionally, tissue characterization on magnetic resonance imaging is particularly useful in differentiating tumor from PE. PPAS has a very poor prognosis which improves by early definitive surgery. Perioperative and late mortality however, remain high. Conclusions Physicians should be alert of this tumor despite its rarity because diagnostic delay increases mortality. In this report, we summarize the features that differentiate PPAS from PE and the importance of imaging in diagnosing the tumor.
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Affiliation(s)
- Rabah Al-Mehisen
- Department of Cardiology, Security Forces Hospital, Riyadh 11481, Saudi Arabia
| | - Zohair Al-Halees
- Cardiac Surgery Section, King Faisal Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 12713, Saudi Arabia
| | - Khalid Alnemri
- Department of Cardiology, Security Forces Hospital, Riyadh 11481, Saudi Arabia
| | - Waleed Al-Hemayed
- Department of Cardiology, King Faisal Specialist Hospital & Research Center, Riyadh 12713, Saudi Arabia
| | - Maha Al-Mohaissen
- Department of Clinical Sciences, Cardiology, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia; Princess Nourah Bint Abdulrahman University Cardiovascular Disease in Women Research Chair, Riyadh, Saudi Arabia.
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28
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Topical issue: advanced imaging and endovascular treatment in pulmonary artery diseases. Int J Cardiovasc Imaging 2019; 35:1405-1406. [PMID: 31292780 DOI: 10.1007/s10554-019-01661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
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