J Cardiovasc Ultrasound.  2015 Mar;23(1):44-47. 10.4250/jcu.2015.23.1.44.

Pulmonary Artery Angiosarcoma Confused with Acute Pulmonary Thromboembolism: Focusing on Clinical and Echocardiographic Features in the Differentiation of Two Categories

• Kim MJ
• Kim MS
• Park JH
• Park KI
• Lee CS
• Na MH
• Lee JH
• Choi SW
• Jeong JO
• Seong IW

• KMID: 2135407
• DOI: http://doi.org/10.4250/jcu.2015.23.1.44

Abstract

Although pulmonary artery angiosarcoma is rare, it can be misdiagnosed as pulmonary embolism because of its similar clinical and diagnostic features. The diagnosis is often delayed and the misdiagnosis brings unnecessary treatment. Because we made a wrong diagnosis of pulmonary artery angiosarcoma as an acute pulmonary embolism, we did thrombolytic therapy which could be dangerous to the patient. In this case report, we focused on the clinical and echocardiographic features of pulmonary artery angiosarcoma which can be used in differentiating the diagnosis from pulmonary embolism.

Keyword

Pulmonary artery angiosarcoma; Pulmonary embolism; Echocardiography; Diagnosis

MeSH Terms

Diagnosis
Diagnostic Errors
Echocardiography*
Hemangiosarcoma*
Humans
Pulmonary Artery*
Pulmonary Embolism*
Thrombolytic Therapy

Figure

• 

  Fig. 1 Modified apical 4 chamber view shows dilated RV (A) and parasternal short axis view demonstrates D-shaped left ventricle indicating pressure overload of RV (B). Parasternal short axis view of the main pulmonary artery (MPA) reveals a mass lesion, about 50 × 30 mm sized, in the proximal part of the MPA with involvement of the pulmonary valves (arrow, C). The color Doppler imaging of the MPA shows flow acceleration during systole and the measured maximal velocity was about 4.6 m/sec (D). Ao: aorta, LV: left ventricle, RV: right ventricle.

• 

  Fig. 2 Chest computerized tomographic scan demonstrates a large, about 58 × 31 mm sized, filling defect occupying the entire MPA with involvement of the pulmonary valves (arrow, A). Surgical finding shows the involvement of the anterior part of MPA and the RVOT (arrowheads, B). Resected tumor masses from the MPA and the RVOT demonstrates several hemorrhagic foci (C). It was divided into two separate parts during removal of the mass. The pathologic specimen demonstrated multiple pleomorphic spindle cells with mitotic figures indicating malignancy (hematoxylin and eosin stain, × 400, D). MPA: main pulmonary artery, RVOT: right ventricular outflow tract.

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