CTICasesIntravascular Sarcoma Metastases and Tumor Thrombotic Microangiopathy
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Imaging findings
Chest CT pulmonary angiogram (CTPA) shows multiple branching, beaded, and V-shaped intravascular filling defects in the pulmonary arteries that grow and progressively expand the vessel lumens over time, associated with severe mosaic lung perfusion, right ventricular enlargement, and interventricular septal flattening.
Key takeaways
Intravascular tumor emboli and metastases from primary sarcomas (such as myxoid sarcoma) can mimic acute or chronic thromboembolic pulmonary hypertension (CTEPH). The diagnostic clue is the progressive enlargement and expansion of the pulmonary arterial branches by the filling defects, rather than the retraction or web formation typical of chronic thromboemboli, and this condition can be associated with microscopic tumor thrombotic microangiopathy (PTTM) leading to rapid right heart failure.
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