1
|
Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Collapse
|
2
|
Kim MS, Lee JH, Hong JH, Hwang IS. [Pulmonary Artery Intimal Sarcoma Involving the Peripheral Pulmonary Artery, Initially Misdiagnosed as Pulmonary Artery Thromboembolism and Vasculitis: A Case Report]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1378-1383. [PMID: 38107677 PMCID: PMC10721428 DOI: 10.3348/jksr.2022.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/15/2023] [Accepted: 06/11/2023] [Indexed: 12/19/2023]
Abstract
Pulmonary artery sarcomas are rare, high-grade malignancies, primarily affecting the proximal elastic pulmonary artery and usually manifesting as tumoral impaction on imaging. Due to similar clinical and imaging findings, pulmonary artery sarcomas are frequently misdiagnosed as pulmonary thromboembolism or, occasionally, as vasculitis. Herein, we reported a case of pulmonary artery intimal sarcoma initially misdiagnosed as pulmonary thromboembolism and vasculitis due to its relatively atypical location and morphology, along with a literature review.
Collapse
|
3
|
Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | | |
Collapse
|
4
|
Tremolada G, Griffin L, Manchester AC, Aboellail T, Lapsley JM, Selmic LE. Primary extraskeletal osteosarcoma of the post-hepatic caudal vena cava in a dog-Case report. Front Vet Sci 2023; 10:1197236. [PMID: 37808103 PMCID: PMC10551124 DOI: 10.3389/fvets.2023.1197236] [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: 07/17/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Extraskeletal osteosarcoma (EOSA) in dogs is a rare malignant mesenchymal tumor of somatic soft tissues or more commonly visceral organs with a poor prognosis. In dogs, EOSAs have been described as arising from multiple locations, but differently from humans, never from a main vessel. In this report, we describe the first case of an EOSA arising from the post-hepatic caudal vena cava in a 7-year-old male neutered mix breed dog. This report focuses on the description of the diagnostic challenges to obtain a preoperative diagnosis, highlights the importance of histopathology for a correct diagnosis, and introduces a new differential diagnosis for an animal presenting with a suspected thrombus of the vena cava.
Collapse
Affiliation(s)
- Giovanni Tremolada
- Flint Animal Cancer Center, Colorado State University College of Veterinary Medicine, Fort Collins, CO, United States
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine, Fort Collins, CO, United States
| | - Lynn Griffin
- Flint Animal Cancer Center, Colorado State University College of Veterinary Medicine, Fort Collins, CO, United States
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine, Fort Collins, CO, United States
| | - Alison C. Manchester
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine, Fort Collins, CO, United States
| | - Tawfik Aboellail
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine, Fort Collins, CO, United States
| | - Janis M. Lapsley
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
| | - Laura E. Selmic
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
5
|
Bartolomé Sánchez A, Inaraja-Pérez GC, Jiménez Elbaile A, Brito MO, Buisán Bardaji JM. Intimal angiosarcoma of the descending aorta presenting as atheroembolism: case report and description of intravascular biopsy. J Vasc Surg Cases Innov Tech 2023; 9:101230. [PMID: 37799831 PMCID: PMC10547730 DOI: 10.1016/j.jvscit.2023.101230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/11/2023] [Indexed: 10/07/2023] Open
Abstract
Aortic sarcoma is a rare entity. In most cases, the diagnosis is established late, owing to the course of the disease, with a median survival time of only a few months. We report the case of a 58-year-old patient with ischemic lesions in the lower limb. The lesions after several investigations were diagnosed by imaging studies (eg, magnetic resonance angiography, contrast-enhanced computed tomography [CT], CT angiography, or positron emission tomography-CT with fluorine-18 fluorodeoxyglucose) as possible primary angiosarcoma of the aorta. It was decided to perform endovascular aortic repair and endovascular biopsy of the lesion. This was chosen as a "palliative" treatment to avoid embolic events, given the presence of metastases, instead of open surgery, which would otherwise have been the treatment of choice. Subsequently, histologic examination confirmed aortic intimal angiosarcoma, and adjuvant chemotherapy was initiated. In the present report, we discuss the clinical presentation, diagnosis, and classification of primary aortic sarcomas. We also critically review the diagnostic and therapeutic management of these patients in previous series of studies to improve their treatment in subsequent cases.
Collapse
Affiliation(s)
| | - Gabriel-Cristian Inaraja-Pérez
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Alfonso Jiménez Elbaile
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Manoela Oliveira Brito
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - José Manuel Buisán Bardaji
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| |
Collapse
|
6
|
Koike T, Iwata H, Hirose K, Minamino T. A case report of pulmonary artery intimal sarcoma negative for 18F-FDG mimicking pulmonary thromboembolism. Eur Heart J Case Rep 2023; 7:ytad140. [PMID: 37123654 PMCID: PMC10141459 DOI: 10.1093/ehjcr/ytad140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/22/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023]
Abstract
Background Pulmonary artery sarcoma is a rare malignant neoplasm arising from intimal mesenchymal cells in the pulmonary artery wall and is often difficult to differentiate from pulmonary embolism, however, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) can be useful for a differential diagnosis. Here, we present a rare case of pulmonary sarcoma undetectable by PET. Case summary A 77-year-old woman who had worsening dyspnoea on effort for a month and progressive chest discomfort with nocturnal cough for a week presented to our hospital. Contrast-enhanced computed tomography (CT) demonstrated a massive filling defect in the left pulmonary artery (PA). Two major differential diagnoses were considered; pulmonary thromboembolism and tumour-like lesions. Positron emission tomography-computed tomography (PET-CT) revealed that there was no abnormal accumulation of 18F-FDG in the mass. However, even after effective anti-thrombotic treatment for 3 weeks, a follow-up CT showed no reduction at all in the size of the lesion in the pulmonary artery. Therefore, surgery for diagnostic therapeutic purposes was performed. Discussion The present case is informative because it supports the idea that being aware of PA angiosarcoma as a potential differential diagnosis of pulmonary thromboembolism is essential, particularly in cases of no evident peripheral venous thrombosis and a negative D-dimer test, even if neither heterogenous contrast enhancement in CT and magnetic resonance imaging nor accumulation of 18-FDG in PET-CT is evident.
Collapse
Affiliation(s)
- Takuma Koike
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hiroshi Iwata
- Corresponding author. Tel: +81-3-3813-3111, Fax: +81-3-5689-0627,
| | - Kuniaki Hirose
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- The Department of Cardiology, Koshigaya Municipal Hospital, 10-32, Higashikoshigaya, Koshigaya, Saitama 343-8577, Japan
| | | |
Collapse
|
7
|
Chambergo-Michilot D, De la Cruz-Ku G, Sterner RM, Brañez-Condorena A, Guerra-Canchari P, Stulak J. Clinical characteristics, management, and outcomes of patients with primary cardiac angiosarcoma: A systematic review. J Cardiovasc Thorac Res 2023; 15:1-8. [PMID: 37342661 PMCID: PMC10278191 DOI: 10.34172/jcvtr.2023.30531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/10/2023] [Indexed: 06/23/2023] Open
Abstract
Primary cardiac angiosarcomas (PCA) are highly aggressive malignant heart tumors. Previous reports have shown a poor prognosis regardless of management, and no consensus or guidelines exist. It is necessary to clarify this information since patients with PCA have a short survival. Therefore, we aimed to systematically review clinical manifestations, management, and outcomes. We systematically searched in PubMed, Scopus, Web of Science, and EMBASE. We intended to include cross-sectional studies, case-control studies, cohort studies, and case series that reported clinical characteristics, management, and outcomes of patients with PCA. As a methodological approach, we used the Joanna Briggs Institute Critical Appraisal Checklist for Case Series and the Newcastle-Ottawa Scale for cohorts. We included six studies (five case series, one cohort). The mean/median age ranged from 39 to 48.9 years. Male sex was predominant. The most frequent manifestations were dyspnea (range: 50%-80%), pericardial effusion (29% & 56%), and chest pain (10%-39%). The mean tumor size ranged from 5.8 to 7.2 cm, with the majority of these localized in the right atrium (70-100%). The most common locations of metastasis were the lung (20%-55.6%), liver (10%-22.2%), and bone (10%-20%). Resection (22.9%-94%), and chemotherapy as neoadjuvant or adjuvant (30%-100%) were the most commonly used methods of treatment. Mortality ranged from 64.7% to 100%. PCA often presents late in its course and usually results in poor prognosis. We strongly recommend performing multi-institutional prospective cohorts to better study disease course and treatments to develop consensus, algorithms, and guidelines for this type of sarcoma.
Collapse
Affiliation(s)
- Diego Chambergo-Michilot
- Universidad Científica del Sur, Lima, Perú
- Department of Cardiology Research, Torres de Salud National Research Center, Lima, Perú
| | - Gabriel De la Cruz-Ku
- Universidad Científica del Sur, Lima, Perú
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Surgery of the University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Ana Brañez-Condorena
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Perú
- Asociación de Investigación Estudiantil en Ciencias de la Salud, Lima, Perú
| | - Pedro Guerra-Canchari
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Perú
- Sociedad Científica de San Fernando, Lima, Perú
| | - John Stulak
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
8
|
Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146:e334-e482. [PMID: 36322642 PMCID: PMC9876736 DOI: 10.1161/cir.0000000000001106] [Citation(s) in RCA: 376] [Impact Index Per Article: 188.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Bruce E Bray
- AHA/ACC Joint Committee on Clinical Data Standards liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Y Joseph Woo
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
| |
Collapse
|
9
|
Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 129] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Collapse
|
10
|
Kaushik KS, Karnavat C, Kakkar R, Desai S. A Rare Case of Multicentric Primary Pulmonary Artery Sarcoma: Eliminating the Masquerade with Multimodality Imaging. Indian J Radiol Imaging 2022; 32:260-265. [PMID: 35924130 PMCID: PMC9340182 DOI: 10.1055/s-0042-1744139] [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] [Indexed: 11/30/2022] Open
Abstract
A 68-year-old male presented with a short history of exertional dyspnea and a provisional diagnosis of pulmonary thromboembolism was made. However, chest radiograph and further investigations in the form of computed tomography pulmonary angiogram, magnetic resonance imaging of thorax, and whole body fluorodeoxyglucose (FDG) positron emission tomography-computed tomography revealed a large mass arising from the distal left pulmonary artery extending into adjacent lung and another lesion near the root of the main pulmonary artery, both of which showed post-contrast enhancement and intense FDG uptake. Tissue sampling by transthoracic computed tomography-guided biopsy and immunohistochemistry confirmed the diagnosis of pulmonary artery angiosarcoma. Here, we present such a case of very rare occurrence which, in view of multicentricity and substantial extension into adjacent lung, is the first of its kind to be reported, to the best of our knowledge.
Collapse
Affiliation(s)
- Kavya S. Kaushik
- Department of Radiology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Chandresh Karnavat
- Department of Radiology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Ritu Kakkar
- Department of Radiology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Shrinivas Desai
- Department of Radiology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| |
Collapse
|
11
|
Ghigna MR, Thomas de Montpreville V. Mediastinal tumours and pseudo-tumours: a comprehensive review with emphasis on multidisciplinary approach. Eur Respir Rev 2021; 30:30/162/200309. [PMID: 34615701 PMCID: PMC9488622 DOI: 10.1183/16000617.0309-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/08/2021] [Indexed: 12/02/2022] Open
Abstract
The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently requiring a multidisciplinary approach. Age and sex represent important information, which need to be integrated with imaging and laboratory findings. In addition, the location of the mediastinal lesion is fundamental; indeed, we propose to illustrate mediastinal diseases based on the compartment of origin. We consider that this structured approach may serve as hint to the diagnostic modalities and management of mediastinal diseases. In this review, we present primary mediastinal tumours in the evolving context of new diagnostic and therapeutic tools, with recently described entities, based on our own experience with >900 cases encountered in the past 10 years. Given the mediastinal anatomical heterogeneity, the correct positioning of mediastinal lesions becomes primal, in order to first establish a clinical suspicion and then to assist in planning biopsy and surgical procedurehttps://bit.ly/3p0gsk3
Collapse
Affiliation(s)
- Maria-Rosa Ghigna
- Dept of Pathology, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | | |
Collapse
|
12
|
Nakamura H, Kanki A, Watanabe H, Ono K, Kuwada N, Saisho S, Nishimura H, Yamamoto A, Tamada T. A case of primary aortic sarcoma with tumor infarction after stent graft placement. Acta Radiol Open 2021; 10:20584601211063360. [PMID: 34900342 PMCID: PMC8664319 DOI: 10.1177/20584601211063360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022] Open
Abstract
Primary aortic sarcoma is a very rare disease, and most primary aortic tumors are
malignant mesenchymal tumors. We present the case of a 62-year-old man with
sudden epigastric and back pain. Contrast-enhanced computed tomography (CT)
revealed a mass lesion about 33.8 mm in diameter, in contact with the left side
of the abdominal aorta. Impending rupture of an abdominal aortic aneurysm was
suspected, so cardiovascular surgery for stent graft placement was performed the
same day. Symptoms immediately improved and CT at 3 months postoperatively
showed a marked decrease in lesion size, but the lesion subsequently grew again.
Fluorodeoxyglucose (FDG)-positron emission tomography/CT was performed due to
the possibility of malignant solid tumor, revealing markedly increased FDG
accumulation (maximum standardized uptake value, 36.95) in the mass lesion.
Primary aortic sarcoma was diagnosed from thoracoscopic biopsy. Here, we report
a primary aortic sarcoma that shrank due to tumor infarction after stent graft
placement, followed by tumor regrowth.
Collapse
Affiliation(s)
- Hiroki Nakamura
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Akihiko Kanki
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | | | - Kentarou Ono
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Noriaki Kuwada
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Shinsuke Saisho
- Department of General Thoracic Surgery, Kawasaki Medical School, Kurashiki, Japan
| | | | - Akira Yamamoto
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Tsutomu Tamada
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| |
Collapse
|
13
|
Xie XJ, Jiang TA, Zhao QY. Diagnostic value of contrast-enhanced ultrasonography in mediastinal leiomyosarcoma mimicking aortic hematoma: A case report and review of literature. World J Clin Cases 2021; 9:9652-9661. [PMID: 34877303 PMCID: PMC8610851 DOI: 10.12998/wjcc.v9.i31.9652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/18/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary mediastinal leiomyosarcomas are extremely rare. We report a case of leiomyosarcoma around the thoracic and abdominal aorta, mimicking an aortic hematoma, and discuss the diagnostic value of ultrasound.
CASE SUMMARY A 63-year-old female was hospitalized for abdominal pain. Initial computed tomography angiography revealed an enhanced mass around the lower thoracic and upper abdominal aorta. Aortic hematoma was strongly suspected, and stents were placed by interventional surgery. About 1 mo postoperatively, the patient was re-hospitalized because of progressive abdominal pain. Ultrasound showed that the mass had a heterogeneous echo. In contrast-enhanced ultrasound, the hyperechoic regions were filled with contrast medium after the aortic region was, indicating that the blood supply was abundant but had no direct connection with the aorta. There was no obvious contrast medium-filling in the hypoechoic area. These findings were similar to those of malignant tumors with liquefaction and necrosis. Positron emission tomography/computed tomography confirmed that the mass had a high metabolic signal similar to that of a malignant tumor. Leiomyosarcoma was confirmed by postoperative pathology.
CONCLUSION Symptoms of mediastinal leiomyosarcoma surrounding the aorta may mimic aortic hematoma. Contrast-enhanced ultrasound can provide valuable and unique diagnostic clues.
Collapse
Affiliation(s)
- Xiu-Jing Xie
- Department of Ultrasound Medicine, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou 310003, Zhejiang Province, China
| | - Tian-An Jiang
- Department of Ultrasound Medicine, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou 310003, Zhejiang Province, China
| | - Qi-Yu Zhao
- Department of Ultrasound Medicine, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou 310003, Zhejiang Province, China
| |
Collapse
|
14
|
Nirattisaikul S, Dechaphunkul A, Hongsakul K. Angiosarcoma of the pulmonary artery mimicking pulmonary thromboembolism. SA J Radiol 2021; 25:2150. [PMID: 34522432 PMCID: PMC8424761 DOI: 10.4102/sajr.v25i1.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022] Open
Abstract
Primary pulmonary angiosarcomas (PPAs) are rare, and often, their diagnosis is delayed because of insidious clinical symptoms and imaging findings mimicking pulmonary thromboembolism (PE). A 33-year-old female patient presented with chest pain and progressive dyspnoea. Her initial diagnosis, based on clinical symptoms and CT pulmonary angiography (PA) findings, was PE. However, after treatment with anticoagulants, the patient failed to improve. A follow-up CTPA and further CT-guided biopsy results were compatible with angiosarcoma.
Collapse
Affiliation(s)
- Sitang Nirattisaikul
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
| | - Arunee Dechaphunkul
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
| | - Keerati Hongsakul
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
| |
Collapse
|
15
|
Keltner CH, Lima APS, West M, Gundle KR, Fuss C, Davis LE. Primary Aortic Angiosarcoma: A Review of Two Cases Highlighting Unique Imaging and Clinical Characteristics. Radiol Cardiothorac Imaging 2021; 3:e210040. [PMID: 34498006 DOI: 10.1148/ryct.2021210040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/08/2021] [Accepted: 06/21/2021] [Indexed: 11/11/2022]
Abstract
Angiosarcomas are rare vascular connective tissue tumors originating from the tunica intima, media, or adventitia and may arise in large vessels. Here two cases of primary angiosarcoma of the aorta are described that highlight initial manifestations and unique complications from diffuse arterial tumor emboli, which led to delayed cancer diagnosis. In patients with aortic lesions, imaging characteristics must be thoughtfully reconciled with clinical scenarios, particularly in patients with no additional evidence of atherosclerosis or vasculitis. Keywords: Oncology, Neoplasms-Primary, MR-Angiography, Aorta © RSNA, 2021.
Collapse
Affiliation(s)
- Case H Keltner
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
| | - Ana Paula Santos Lima
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
| | - Malinda West
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
| | - Kenneth R Gundle
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
| | - Cristina Fuss
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
| | - Lara E Davis
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
| |
Collapse
|
16
|
Primary Soft Tissue Sarcoma of the Heart: An Emerging Chapter in Cardio-Oncology. Biomedicines 2021; 9:biomedicines9070774. [PMID: 34356838 PMCID: PMC8301302 DOI: 10.3390/biomedicines9070774] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
Primary malignant cardiac tumors are rare, with a prevalence of about 0.01% among all cancer histotypes. At least 60% of them are primary soft tissue sarcomas of the heart (pSTS-h) that represent almost 1% of all STSs. The cardiac site of origin is the best way to classify pSTS-h as it is directly linked to the surgical approach for cancer removal. Indeed, histological differentiation should integrate the classification to provide insights into prognosis and survival expectancy of the patients. The prognosis of pSTS-h is severe and mostly influenced by the primary localization of the tumor, the difficulty in achieving complete surgical and pharmacological eradication, and the aggressive biological features of malignant cells. This review aims to provide a detailed literature overview of the most relevant issues on primary soft tissue sarcoma of the heart and highlight potential diagnostic and therapeutic future perspectives.
Collapse
|
17
|
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.
Collapse
|
18
|
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.
Collapse
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.)
| |
Collapse
|
19
|
Li YC, Li LY, Tong HC, Xu HT, Ma S, Yang LH, Zhang WL, Sotolongo G, Wang E. Pulmonary artery intimal sarcoma mimicking pulmonary thromboembolism: A case report. Medicine (Baltimore) 2021; 100:e24699. [PMID: 33578605 PMCID: PMC10545097 DOI: 10.1097/md.0000000000024699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Pulmonary artery intimal sarcoma is a rare tumor with exceptionally high mortality and easily misdiagnosed as pulmonary thromboembolism pulmonary thromboembolism (PTE) due to the nonspecific clinical presentation and symptom. Misdiagnosis or untimely diagnosis makes the disease progress to an advanced stage and eventually leads to a poor prognosis. PATIENT CONCERNS A 37-year-old Chinese female presented with chest tightness and dyspnea for 3 months. Echocardiography and chest computed tomography revealed an intraluminal obstruction of the pulmonary arteries. Tests of serum tumor makers showed slight elevation for carbohydrate antigen-125, and α-fetoprotein. PTE was suspected according to the radiological and laboratory findings. DIAGNOSIS Microscopic findings of the presumed thrombus showed prominent myxoid and edematous background with atypical spindled cells and curvilinear vascularity. Immunohistochemical staining demonstrated that the atypical spindled cells were positive for vimentin but negative for CK, S100, SMA, desmin, CD68, STAT6, CD34, β-catenin, ALK-p80, p53, and MDM2. According to the radiological and pathological findings, the diagnosis of fibrosarcoma of pulmonary artery was made. INTERVENTIONS The patient underwent surgical resection and the mass was excised as completely as possible. OUTCOME Follow-up information showed no evidence of recurrence or metastasis after 3 months postresection. LESSONS Because of the low incidence rate, nonspecific clinical symptoms, and radiological findings, primary fibrosarcoma of the pulmonary artery is commonly misdiagnosed as PTE. Pathological examination is necessary to confirm the diagnosis.
Collapse
Affiliation(s)
- Ying-Chun Li
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Le-Yao Li
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Hai-Chao Tong
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Hong-Tao Xu
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Shuang Ma
- Department of Neurology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning
| | - Lian-He Yang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Wan-Lin Zhang
- Department of Pathology, Hebei Petro China Central Hospital, Langfang, Hebei, China
| | - Gina Sotolongo
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Issakwisa M, Mwakyusa N, Torres L, Ngatunga C, Chaula B, Maro H, Mboma L, Nguma I, Nqwata L, Mujwahuzi L. Metastatic angiosarcoma of unknown primary site misdiagnosed as tuberculosis. Clin Case Rep 2020; 8:3018-3023. [PMID: 33363871 PMCID: PMC7752315 DOI: 10.1002/ccr3.3243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/08/2020] [Accepted: 07/26/2020] [Indexed: 11/10/2022] Open
Abstract
Tuberculosis in endemic areas is likely to be overdiagnosed in patients with atypical clinical and imaging findings mimicking tuberculosis, as in our case of angiosarcoma. Detailed history, physical examination, imaging, and histopathology avert diagnosis of tumors as tuberculosis in resource-limited settings, where countless diseases have common clinical and imaging presentations.
Collapse
Affiliation(s)
- Mwakyula Issakwisa
- Department of Internal MedicineMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Ngwilo Mwakyusa
- Department of RadiologyMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Liset Torres
- Department of PathologyMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Cecilia Ngatunga
- Department of RadiologyMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Baraka Chaula
- Department of Internal MedicineMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Haika Maro
- Department of RadiologyMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Lazaro Mboma
- Department of SurgeryMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Irene Nguma
- Department of Internal MedicineMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Lamla Nqwata
- Division of PulmonologyChris Hani Baragwanath Academic HospitalBertshamSouth Africa
- University of the WitwatersrandJohannesburgSouth Africa
| | - Leodegard Mujwahuzi
- Department of Internal MedicineMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| |
Collapse
|
22
|
Wilson NR, Canache AS, Lee MT, Zhao B, Balan P, Iliescu CA. Primary angiosarcoma of the ascending aorta presenting with acute coronary syndrome. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2020. [DOI: 10.1016/j.cpccr.2020.100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
23
|
Wang J, Li TL, Zheng S. A primary pulmonary artery sarcoma associated with multiple lesions. World J Emerg Med 2020; 11:270-273. [PMID: 33014227 DOI: 10.5847/wjem.j.1920-8642.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jing Wang
- Department of Geriatric, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Tian-Lang Li
- Department of Geriatric, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shu Zheng
- Institution of Tumor, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
24
|
Vacirca A, Faggioli G, Pini R, Freyrie A, Indelicato G, Fenelli C, Bacchi Reggiani ML, Vasuri F, Pasquinelli G, Stella A, Gargiulo M. Predictors of survival in malignant aortic tumors. J Vasc Surg 2019; 71:1771-1780. [PMID: 31862201 DOI: 10.1016/j.jvs.2019.09.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/10/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Malignant aortic tumors (MATs) are exceedingly rare, and a comprehensive review of clinical and therapeutic aspects is lacking in the literature. The aim of this study was to analyze all known cases of MATs and to identify predictors of patients' survival. METHODS All patients diagnosed with an aortic tumor treated in a single center along with all case reports and reviews available in the literature through a specific PubMed search using keywords such as "malignant" and "aorta" or "aortic," "tumor," or "sarcoma" or "angiosarcoma" were analyzed. The tumor's primary location, clinical presentation, histologic subtype, and treatment choice were examined. Survival at 1 year, 3 years, and 5 years and the possible preoperative and operative outcome predictors were evaluated using Kaplan-Meier analysis with a log-rank test and by Cox regression for multivariate analysis. RESULTS In addition to the 5 cases treated in our center, 218 other cases of MAT were reported in the literature from 1873 to 2017. The mean age of the patients was 60.1 ± 11.9 years, and the male to female ratio was 1.59:1. The median overall survival from diagnosis was 8 (7-9) months; 1-, 3-, and 5-year survival rates were 26%, 7.6%, and 3.5%, respectively. Chronic hypertension (P = .03), fever (P = .03), back pain (P = .01), asthenia (P = .04), and signs of peripheral embolization (P = .007) were significant predictors of a poor result. Histologic subtypes had a different impact on survival, with no statistical significance. Compared with other treatment strategies, combined surgical-medical therapy had the best impact on the median survival rate (surgical-medical, 12 [8-24] months; medical, 8 [5-10] months; surgical 7 [2-16] months; no treatment, 2 [0.5-15] months; P = .001). Analyzing exclusively medical approaches, chemotherapy and radiotherapy had the best impact on median survival rate compared with untreated patients (chemotherapy-radiotherapy, 18 [10-26] months; radiotherapy, 16 [8-20] months; chemotherapy, 10 [7-24] months; no medical treatment, 6 [2-16] months; P = .005); these data were not sustained by multivariate analysis. CONCLUSIONS Aortic tumors are a malignant pathologic condition with a short survival rate after initial diagnosis. Survival is further diminished in the presence of clinical factors such as hypertension, fever, back pain, asthenia, and signs of peripheral embolization. Combined surgical and medical treatment, particularly with chemotherapy and radiotherapy, has shown the highest survival rate.
Collapse
Affiliation(s)
- Andrea Vacirca
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gianluca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
| | - Rodolfo Pini
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Antonio Freyrie
- Vascular Surgery, University of Parma, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Giuseppe Indelicato
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Cecilia Fenelli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Maria Letizia Bacchi Reggiani
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Francesco Vasuri
- Anatomical Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gianandrea Pasquinelli
- Anatomical Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Andrea Stella
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| |
Collapse
|
25
|
Chiola I, Belgioia L, Vaccara EML, Gusinu M, Corvò R. Reirradiation of pulmonary artery intimal sarcoma: A case report. Clin Case Rep 2019; 7:1342-1346. [PMID: 31360482 PMCID: PMC6637327 DOI: 10.1002/ccr3.2216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/02/2019] [Accepted: 05/05/2019] [Indexed: 11/23/2022] Open
Abstract
We report here the case of a patient with 4 years long-term survival after treatment with surgery, chemotherapy, and radiotherapy with good local control. This case highlights the possible role of radiation therapy in this tumor.
Collapse
Affiliation(s)
- Ilaria Chiola
- Health Science Department (DISSAL)University of GenoaGenoaItaly
| | - Liliana Belgioia
- Health Science Department (DISSAL)University of GenoaGenoaItaly
- Radiation Oncology DepartmentIRCCS San Martino HospitalGenoaItaly
| | | | - Marco Gusinu
- Medical Physics DepartmentIRCCS San Martino HospitalGenoaItaly
| | - Renzo Corvò
- Health Science Department (DISSAL)University of GenoaGenoaItaly
- Radiation Oncology DepartmentIRCCS San Martino HospitalGenoaItaly
| |
Collapse
|
26
|
Aortic mural leiomyosarcoma with spinal involvement. J Thorac Cardiovasc Surg 2019; 159:e249-e254. [PMID: 31128902 DOI: 10.1016/j.jtcvs.2019.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/22/2019] [Accepted: 04/02/2019] [Indexed: 12/14/2022]
|
27
|
Primary Cardiac Angiosarcoma: Authors' Perspective Following Synthesis of Available Literature. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Multimodal Approach of Pulmonary Artery Intimal Sarcoma: A Single-Institution Experience. Sarcoma 2017; 2017:7941432. [PMID: 28912665 PMCID: PMC5585613 DOI: 10.1155/2017/7941432] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/05/2017] [Indexed: 01/11/2023] Open
Abstract
Introduction Pulmonary artery sarcoma (PAS) is a rare tumor, whose therapeutic approach is mainly based on surgery, either pneumonectomy or pulmonary endarterectomy (PEA). The prognosis reported in published series is very poor, with survival of 1.5 months without any kind of treatment. Patients and Methods From January 2010 to January 2016, 1027 patients were referred to our hospital for symptoms of acute or chronic pulmonary thromboembolic disease. Twelve patients having a confirmed diagnosis of PAS underwent PEA. Median age was 64.5 years. Most patients had a long history of symptoms, having a median time of 7.5 months from onset of symptoms to surgery. Results Following PEA and cardiopulmonary rehabilitation, 10 patients received conventional chemotherapy with doxorubicin and ifosfamide, starting at a median of 42 days from surgery. Four patients also received radiotherapy. Four patients have died due to disease progression, while 7 are still alive, with 5 being disease-free at 4–55+ months from diagnosis. Conclusions In patients with PAS, a multimodal approach including PEA, CT, and RT is feasible but it should be evaluated individually, according to the tumor extension and the patient's clinical condition. Apart from improving quality of life mainly by reducing or delaying symptoms due to PH, it may improve life expectancy.
Collapse
|
29
|
Liu M, Luo C, Wang Y, Guo X, Ma Z, Yang Y, Zhang T. Multiparametric MRI in differentiating pulmonary artery sarcoma and pulmonary thromboembolism: a preliminary experience. Diagn Interv Radiol 2017; 23:15-21. [PMID: 27919861 DOI: 10.5152/dir.2016.15584] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to define multiparametric magnetic resonance imaging (MRI) findings to differentiate between pulmonary artery sarcoma (PAS) and pulmonary thromboembolism (PTE). METHODS Eleven patients with suspected PTE were prospectively included to undergo pulmonary MRI before surgery or biopsy. MRI protocol included an unenhanced sequence, diffusion-weighted imaging (DWI, b=800 s/mm2) and a dynamic contrast-enhanced sequence. Morphologic characteristics including distribution, filling defect, and intensity were observed on T1-, T2-, and fat-suppressed T2-weighted imaging, DWI, and contrast-enhanced MRI. Apparent diffusion coefficient (ADC) values were calculated. RESULTS Six patients were pathologically diagnosed as PAS and the other five as chronic PTE. There were no significant differences in age, gender, presenting symptoms, D-dimer, and N-terminal pro-brain natriuretic peptide between the two groups (P > 0.05). Among MRI findings that were tested for their ability to diagnose PAS, area under the curve (AUC) was significantly higher than 0.5 for main pulmonary artery involvement (AUC, 0.83±0.13; P = 0.011), hyperintensity on fat-suppressed T2-weighted imaging (AUC, 0.82±0.14; P = 0.025), hyperintensity on DWI (AUC, 0.88±0.12; P = 0.002), contrast enhancement (AUC, 0.92±0.10; P < 0.001) and pleural effusion (AUC, 0.82±0.14; P = 0.025). Moreover, grape-like appearance in distal pulmonary artery and cardiac invasion had 100% specificity for diagnosis of PAS. However, ADC value of PAS was not significantly different than that of chronic PTE (U, 12.00; P = 0.584). CONCLUSION Hyperintense filling defect in main pulmonary artery on fat-suppressed T2-weighted imaging and DWI and contrast enhancement may help to discriminate PAS from PTE.
Collapse
Affiliation(s)
- Min Liu
- Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China.
| | | | | | | | | | | | | |
Collapse
|
30
|
Gaballah AH, Jensen CT, Palmquist S, Pickhardt PJ, Duran A, Broering G, Elsayes KM. Angiosarcoma: clinical and imaging features from head to toe. Br J Radiol 2017; 90:20170039. [PMID: 28471264 DOI: 10.1259/bjr.20170039] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Angiosarcoma is a rare, aggressive subtype of soft-tissue sarcoma with a propensity for local recurrence and metastasis associated with a generally poor prognosis, unless diagnosed early. Given the vascular endothelial cell origin of angiosarcoma, tumours may develop in essentially any organ; however, there is a predilection for the skin where half of all tumours arise, increasing in prevalence with age. The most common risk factors are chronic lymphoedema and history of radiation. We review the most important radiological findings along the spectrum of angiosarcoma from head to toe throughout the body, including uncommon and rare locations. Key imaging features of angiosarcoma across multiple organ systems will be described, as well as the impact on management and prognosis.
Collapse
Affiliation(s)
- Ayman H Gaballah
- 1 Department of Diagnostic Radiology, University of Missouri-Columbia, Columbia, MO, USA
| | - Corey T Jensen
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah Palmquist
- 3 Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Perry J Pickhardt
- 4 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Alper Duran
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory Broering
- 3 Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Khaled M Elsayes
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
31
|
June AS, Harris DG, Yoo C, Garrido D, Toursavadkohi S, Sarkar R, Crawford RS. Percutaneous Treatment of Multiple Recurrent Thromboembolization from a Descending Thoracic Aortic Intimal Sarcoma. Ann Vasc Surg 2016; 38:321.e5-321.e8. [PMID: 27671453 DOI: 10.1016/j.avsg.2016.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 06/24/2016] [Indexed: 11/15/2022]
Abstract
Aortic intimal sarcomas are rare tumors that may result in distal embolic ischemia. Here, we present a patient who presented with crescendo lower extremity and mesenteric ischemic events from malignant macroembolism. Management with percutaneous pharmacomechanical thromboembolectomy enabled restoration of distal perfusion and minimally invasive collection of tumor sample to confirm the suspected diagnosis of aortic sarcoma. The patient underwent definitive aortectomy and reconstruction and is recovering well.
Collapse
Affiliation(s)
- Angelina S June
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Donald G Harris
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
| | - Christine Yoo
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Danon Garrido
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, MD
| | - Rajabrata Sarkar
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, MD
| | - Robert S Crawford
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, MD
| |
Collapse
|
32
|
Percutaneous Intravascular Biopsy Using a Bronchoscopy Forceps Diagnosis of a Pulmonary Artery Intimal Sarcoma. Cardiovasc Intervent Radiol 2016; 40:318-319. [DOI: 10.1007/s00270-016-1475-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
|
33
|
Toyoda Y, Ozaki R, Kishi J, Hanibuchi M, Kinoshita K, Tezuka T, Goto H, Ono H, Nagai K, Bando Y, Doi T, Nishioka Y. An Autopsy Case of Aortic Intimal Sarcoma Initially Diagnosed as Polyarteritis Nodosa. Intern Med 2016; 55:3191-3195. [PMID: 27803418 PMCID: PMC5140873 DOI: 10.2169/internalmedicine.55.7152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A 61-year-old man had hypertension with stenosis in the left renal artery. When his fever, abdominal pain, and renal dysfunction progressed, he was admitted to our hospital. He was diagnosed with polyarthritis nodosa. His renal function rapidly deteriorated despite immunosuppressive therapy. His digestive tract perforated twice, and he subsequently died. An autopsy revealed that aortic intimal sarcoma caused stenosis in multiple arteries. Both polyarteritis nodosa and aortic intimal sarcoma are very rare diseases and the diagnoses are very difficult. It is very important to consider these entities when making a differential diagnosis of vasculitis.
Collapse
Affiliation(s)
- Yuko Toyoda
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Manlove W, Raptis CA, Bhalla S. Pitfalls in computed tomography of the aorta. Semin Roentgenol 2015; 50:229-34. [PMID: 26002244 DOI: 10.1053/j.ro.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Whitney Manlove
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO.
| |
Collapse
|
35
|
Ghigna MR, Hamdi S, Petitpretz P, Rohnean A, Florea V, Mussot S, Dartevelle P, Dorfmuller P, Tu L, Thuillet R, Guignabert C, Thomas-de-Montpreville V. Angiomatoid fibrous histiocytoma of the pulmonary artery: a multidisciplinary discussion. Histopathology 2014; 65:278-82. [DOI: 10.1111/his.12429] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maria-Rosa Ghigna
- Department of Pathology; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
- INSERM UMR 999; LabEx LERMIT; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
- School of Medicine; University Paris-Sud; Kremlin-Bicêtre France
| | - Sarah Hamdi
- Department of Thoracic Surgery; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
| | - Patrick Petitpretz
- Department of Pneumology; Centre Hospitalier de Versailles; Le Chesnay France
| | - Adela Rohnean
- Department of Radiology; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
| | - Valentina Florea
- Department of Thoracic Surgery; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
| | - Sacha Mussot
- Department of Thoracic Surgery; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
| | - Philippe Dartevelle
- Department of Thoracic Surgery; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
| | - Peter Dorfmuller
- Department of Pathology; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
- INSERM UMR 999; LabEx LERMIT; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
- School of Medicine; University Paris-Sud; Kremlin-Bicêtre France
| | - Ly Tu
- INSERM UMR 999; LabEx LERMIT; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
- School of Medicine; University Paris-Sud; Kremlin-Bicêtre France
| | - Raphaël Thuillet
- INSERM UMR 999; LabEx LERMIT; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
- School of Medicine; University Paris-Sud; Kremlin-Bicêtre France
| | - Christophe Guignabert
- INSERM UMR 999; LabEx LERMIT; Marie Lannelongue Surgical Centre; Le Plessis-Robinson France
- School of Medicine; University Paris-Sud; Kremlin-Bicêtre France
| | | |
Collapse
|
36
|
Rusthoven CG, Liu AK, Bui MM, Schefter TE, Elias AD, Lu X, Gonzalez RJ. Sarcomas of the Aorta: A Systematic Review and Pooled Analysis of Published Reports. Ann Vasc Surg 2014; 28:515-25. [DOI: 10.1016/j.avsg.2013.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 12/19/2022]
|
37
|
von Falck C, Meyer B, Fegbeutel C, Länger F, Bengel F, Wacker F, Rodt T. Imaging features of primary sarcomas of the great vessels in CT, MRI and PET/CT: a single-center experience. BMC Med Imaging 2013; 13:25. [PMID: 23924063 PMCID: PMC3750466 DOI: 10.1186/1471-2342-13-25] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 08/06/2013] [Indexed: 11/23/2022] Open
Abstract
Background To investigate the imaging features of primary sarcomas of the great vessels in CT, MRI and 18 F-FDG PET/CT. Methods Thirteen patients with a primary sarcoma of the great vessels were retrospectively evaluated. All available images studies including F-18 FDG PET(/CT) (n = 4), MDCT (n = 12) and MRI (n = 6) were evaluated and indicative image features of this rare tumor entity were identified. Results The median interval between the first imaging study and the final diagnosis was 11 weeks (0–12 weeks). The most frequently observed imaging findings suggestive of malignant disease in patients with sarcomas of the pulmonary arteries were a large filling defect with vascular distension, unilaterality and a lack of improvement despite effective anticoagulation. In patients with aortic sarcomas we most frequently observed a pedunculated appearance and an atypical location of the filling defect. The F-18 FDG PET(/CT) examinations demonstrated an unequivocal hypermetabolism of the lesion in all cases (4/4). MRI proved lesion vascularization in 5/6 cases. Conclusion Intravascular unilateral or atypically located filling defects of the great vessels with vascular distension, a pedunculated shape and lack of improvement despite effective anticoagulation are suspicious for primary sarcoma on MDCT or MRI. MR perfusion techniques can add information on the nature of the lesion but the findings may be subtle and equivocal. F-18 FDG PET/CT may have a potential role in these patients and may be considered as part of the imaging workup.
Collapse
|
38
|
Fatima J, Duncan AA, Maleszewski JJ, Kalra M, Oderich GS, Gloviczki P, Suri RM, Bower TC. Primary angiosarcoma of the aorta, great vessels, and the heart. J Vasc Surg 2013; 57:756-64. [DOI: 10.1016/j.jvs.2012.09.023] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 08/30/2012] [Accepted: 09/04/2012] [Indexed: 11/17/2022]
|
39
|
Current World Literature. Curr Opin Oncol 2012; 24:454-60. [DOI: 10.1097/cco.0b013e328355876c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|