Hmelik Stjepan, Dobrenić Margareta, Huić Dražen
General Hospital Varazdin, I. Mestrovica b.b., 42000 Varazdin, Croatia; University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
Nucl Med Rev Cent East Eur. 2018;21(1):48-49. doi: 10.5603/NMR.a2018.0011.
Pulmonary artery sarcomas (PAS's) are extremely rare malignant tumors that arise from the endothelial lining of the pulmonary arteries. On CT scans PAS's appear as intraluminal filling defects in the pulmonary arteries, mimicking pulmonary embolism (PE). Due to the similarities in radiographic features as well as in clinical presentation, PAS's are usually misdiagnosed as pulmonary embolism. Since PASs are F-18 FDG avid, F-18 FDG PET/CT scan is a useful imaging tool for differentiating between these two conditions, as shown in this case report. We report a case of a 60-year-old woman presented with a 6-month history of chest pain, dyspnea on exertion, non-productive cough and weight loss. The initial CT pulmonary artery angiography showed extensive intraluminal mass in the pulmonary trunk and left pulmonary artery, diagnosed as massive pulmonary embolism. Since there was no clinical improvement after anticoagulant therapy, CT pulmonary angiography was repeated, and with no change observed in the intraluminal filling defect in pulmonary trunk, the possibility of tumor was raised. For further evaluation of a possible malignancy, F-18 FDG PET/CT was performed. It showed increased FDG uptake, suspicious for an aggressive tumor, in the intraluminal lesion of the pulmonary trunk and along the wall of the left pulmonary artery. There was no extrathoracic abnormality seen on PET/CT scan. Histopathological finding after complete pulmonary artery resection showed high grade undifferentiated pleomorphic sarcoma. F-18 FDG PET/CT is a useful tool for differentiating between pulmonary embolism and malignant intraluminal mass, and at the same time it enables the proper staging of the malignancy. < p > < /p >.
肺动脉肉瘤（PAS）是极为罕见的恶性肿瘤，起源于肺动脉的内皮细胞层。在CT扫描上，PAS表现为肺动脉内的腔内充盈缺损，酷似肺栓塞（PE）。由于其影像学特征和临床表现相似，PAS通常被误诊为肺栓塞。由于PAS摄取F-18 FDG，F-18 FDG PET/CT扫描是区分这两种情况的有用成像工具，本病例报告即展示了这一点。我们报告一例60岁女性，有6个月胸痛、劳力性呼吸困难、干咳和体重减轻的病史。最初的CT肺动脉造影显示肺动脉主干和左肺动脉内有广泛的腔内肿块，诊断为大面积肺栓塞。抗凝治疗后临床症状无改善，遂再次进行CT肺动脉造影，发现肺动脉主干内的腔内充盈缺损无变化，于是怀疑为肿瘤。为进一步评估可能的恶性肿瘤，进行了F-18 FDG PET/CT检查。结果显示肺动脉主干腔内病变及左肺动脉壁FDG摄取增加，怀疑为侵袭性肿瘤。PET/CT扫描未发现胸外异常。肺动脉完全切除术后的组织病理学检查显示为高级别未分化多形性肉瘤。F-18 FDG PET/CT是区分肺栓塞和恶性腔内肿块的有用工具，同时还能对恶性肿瘤进行准确分期。
