Ng Fung Him, Yu San Ming, Wai Ophelia Ka Heng, Chan James Chi Sang
Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong.
J Clin Imaging Sci. 2017 Aug 24;7:33. doi: 10.4103/jcis.JCIS_71_16. eCollection 2017.
Primary pulmonary angiosarcoma is extremely rare. It is often characterized by a clinically indolent course and delayed diagnosis. To date, there have been <20 cases reported. By far, little article correlates the clinical presentation, the imaging findings with the pathology. The authors present a case of middle-aged gentleman with primary pulmonary epithelioid angiosacroma which we initially thought as tuberculosis (TB) infection. A 60-year-old gentleman, with a history of 6 months on and off blood stained sputum, was admitted for an episode of massive hemoptysis. Urgent computed tomography (CT) bronchial arteriogram excluded any dilated bronchial artery. Patchy consolidation with multiple small centrilobular ground-glass nodules was noted at left upper lobe. The bronchoscopy was negative for malignancy and infection. Autoimmune workup was negative. Despite negative bronchoscopy, fungal, acid-fast bacilli culture and cytology, and anti-TB treatment were empirically given. However, his hemoptysis was unresolved. He was followed up with high-resolution CT after a month showed an enlarging left upper lobe mass surrounding by a ground glass halo. Left thoracotomy and left upper lobe lobectomy were performed. Epithelioid angiosacroma was found in histology. Radiologic and clinical-pathological findings were correlated in this paper.
原发性肺血管肉瘤极为罕见。其临床过程通常较为隐匿，诊断往往延迟。迄今为止，报道的病例不足20例。到目前为止，很少有文章将临床表现、影像学表现与病理学联系起来。作者报告了一例中年男性原发性肺上皮样血管肉瘤病例，我们最初认为是结核感染。一名60岁男性，有6个月间断咯血痰病史，因一次大量咯血入院。紧急计算机断层扫描（CT）支气管动脉造影排除了任何扩张的支气管动脉。左上叶可见斑片状实变影，伴有多个小叶中心性小结节状磨玻璃影。支气管镜检查未发现恶性肿瘤和感染。自身免疫检查结果为阴性。尽管支气管镜检查结果为阴性，但仍经验性给予抗真菌、抗酸杆菌培养及细胞学检查，并给予抗结核治疗。然而，他的咯血症状仍未缓解。一个月后进行高分辨率CT随访，显示左上叶肿块增大，周围有磨玻璃晕。行左胸切开术及左上叶切除术。组织学检查发现为上皮样血管肉瘤。本文对影像学和临床病理结果进行了相关性分析。
