Piscitelli Laura, Dentamaro Ilaria, Pezzicoli Gaetano, D'Agostino Carlo
Cardiology Unit, Department of Emergency and Organ Transplant, University Hospital Policlinico of Bari, Piazza Giulio Cesare, 11 70124 (BARI), Italy.
Cardiology Unit, Miulli Hospital, Strada provinciale 127 Acquaviva-Santeramo, 70021 Acquaviva delle Fonti (BARI), Italy.
Eur Heart J Case Rep. 2021 Jan 4;5(2):ytaa551. doi: 10.1093/ehjcr/ytaa551. eCollection 2021 Feb.
Primary pulmonary artery masses are unusual entities that mimic pulmonary embolism (PE) in clinical presentation and on imaging studies. It is necessary to perform advanced diagnostic exams, such as transesophageal echocardiography (TEE) and cardiac magnetic resonance imaging (MRI), to determine the proper diagnosis. In unclear cases, laboratory findings, morphological follow-up, and response to anticoagulant therapy can help to clarify the diagnosis.
A 47-year-old previously healthy man with worsening effort dyspnoea underwent chest computed tomography (CT) for suspicion of PE, which showed a pedunculated eccentric mass at the origin of the pulmonary artery causing severe stenosis. The patient was started on anticoagulation therapy, but, after TEE and cardiac MRI, a neoplastic fibroelastic mass was suspected. Unexpectedly, fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT revealed a unique area of glucose uptake in the superior lobe of the left lung and not in the pulmonary artery. The biopsy was consistent with pleomorphic high-grade lung sarcoma. After 3 months of chemotherapy, a CT scan showed progression of the lung disease with no change in the arterial mass, which was therefore confirmed as pulmonary fibroelastoma.
Due to the rarity of pulmonary artery tumours, they can be initially misdiagnosed as PE or a metastasis of a lung sarcoma. Three-dimensional TEE and cardiac MRI are particularly useful in differentiating tumours from PE.
原发性肺动脉肿块是一种不常见的疾病，在临床表现和影像学检查中易被误诊为肺栓塞（PE）。有必要进行高级诊断检查，如经食管超声心动图（TEE）和心脏磁共振成像（MRI），以明确诊断。在诊断不明确的病例中，实验室检查结果、形态学随访以及对抗凝治疗的反应有助于明确诊断。
一名47岁既往健康的男性，因劳力性呼吸困难加重接受胸部计算机断层扫描（CT）检查，怀疑为PE，结果显示肺动脉起始处有一个带蒂的偏心性肿块，导致严重狭窄。患者开始接受抗凝治疗，但在进行TEE和心脏MRI检查后，怀疑为肿瘤性纤维弹性肿块。出乎意料的是，氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）-CT显示左肺上叶有一个独特的葡萄糖摄取区域，而肺动脉中没有。活检结果与多形性高级别肺肉瘤一致。化疗3个月后，CT扫描显示肺部疾病进展，动脉肿块无变化，因此确诊为肺纤维弹性瘤。
由于肺动脉肿瘤罕见，最初可能被误诊为PE或肺肉瘤转移。三维TEE和心脏MRI在鉴别肿瘤与PE方面特别有用。
