Farsad Mohsen, Pernter Patrizia, Triani Antonio, Osele Luzian, Wiedermann Christian J
Department of Nuclear Medicine, Central Hospital of Bolzano, Bolzano, Italy.
Clin Nucl Med. 2009 Apr;34(4):239-40. doi: 10.1097/RLU.0b013e31819a1f7b.
Pulmonary artery sarcoma, although rare, must be considered in the differential diagnosis of pulmonary thromboembolism. Clinically and radiologically, it may imitate pulmonary embolism, making diagnosis difficult and delaying treatment. Patients often have no symptom resolution despite therapeutic anticoagulation. Visualization of filling defects within a pulmonary artery on contrast-enhanced CT cannot reliably differentiate between pulmonary thromboembolism and malignant lesions like leiomyosarcoma. FDG PET-CT offers the potential for identification of malignant lesions. The authors report a case with pulmonary artery thromboembolism due to thrombi formed on a pulmonary artery leiomyosarcoma. Integrated FDG PET-CT showed no FDG-uptake along the major part of the filling defect within the right main pulmonary artery suggesting blood clot and increased uptake along the posterior wall of the right main pulmonary artery and the left lower lobar artery suggesting malignancy.
肺动脉肉瘤虽然罕见，但在肺血栓栓塞的鉴别诊断中必须予以考虑。在临床和放射学方面，它可能酷似肺栓塞，从而导致诊断困难并延误治疗。尽管进行了抗凝治疗，患者的症状往往仍无缓解。在增强CT上肺动脉内充盈缺损的显影并不能可靠地区分肺血栓栓塞和诸如平滑肌肉瘤等恶性病变。FDG PET-CT为识别恶性病变提供了可能。作者报告了一例因肺动脉平滑肌肉瘤上形成血栓而导致肺动脉血栓栓塞的病例。综合FDG PET-CT显示，右主肺动脉内充盈缺损的主要部分未见FDG摄取，提示为血凝块，而右主肺动脉后壁和左下叶动脉处FDG摄取增加，提示为恶性病变。
