CTICasesChronic Pulmonary Thromboembolism Mimicking Sarcoma
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Imaging findings
An outside CT read revealed a filling defect in the left pulmonary artery with an irregular margin, expanding the vessel and extending into the lingula and lower lobe. A prominent, juicy left bronchial artery was noted. Lung windows showed multiple peripheral infarcts at different stages of evolution, characterized by dense rims and lucent cores, some cavitating and confluent. Despite these findings, the patient was largely asymptomatic, but had a DVT. Pulmonary MRI subsequently demonstrated no enhancement of the lesion on first-pass or delayed sequences.
Key takeaways
This case highlights the diagnostic challenge of differentiating chronic pulmonary thromboembolism from pulmonary artery sarcoma, especially given the irregular morphology and vessel expansion on CT. The lack of enhancement on contrast-enhanced MRI was crucial in ruling out sarcoma and confirming the diagnosis of chronic, non-enhancing clot. The patient's asymptomatic presentation despite extensive infarction and resulting 'auto-lobectomy' by the clot, along with hypervascularity from the bronchial artery, is also noteworthy.
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