CTICasesPulmonary Artery Metastasis from High-Grade Sarcoma
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Imaging findings
A patient with a history of humerus resection for sarcoma presents with what was initially diagnosed as a massive pulmonary embolism unresponsive to anticoagulation and lytic therapy. Delayed CTA imaging demonstrates progressive enhancement of the large filling defect in the pulmonary artery, distinguishing it from thrombus and suggesting tumor. Additionally, there are areas of ground glass opacity and consolidation in the lung, possibly representing hemorrhagic infarction or hemorrhage from prior lytic therapy.
Key takeaways
A large pulmonary artery lesion mimicking a pulmonary embolism, particularly when resistant to conventional antithrombotic treatment, should raise strong suspicion for a pulmonary artery sarcoma or metastasis. Progressive enhancement on delayed imaging is a key differentiator from bland thrombus. This case highlights a high-grade metastatic spindle cell sarcoma to the pulmonary artery, an impressive manifestation of metastatic disease.
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