CTICasesMassive Unilateral Pulmonary Embolism Mimicking Pulmonary Artery Sarcoma
Imaging findings
CT demonstrates a large filling defect occupying the entire left main pulmonary artery with distal obstruction, in a patient with documented deep vein thrombosis. There is no expansion of the pulmonary artery lumen beyond normal caliber. Follow-up CT after treatment shows the filling defect has contracted and shows findings of chronic thromboembolic disease including webs and irregular intimal surfaces. Pathologic specimen from the patient shows canalized thrombus.
Key takeaways
Massive unilateral pulmonary embolism filling the main pulmonary artery can mimic the appearance of intimal sarcoma on CT. Key distinguishing features favoring thromboembolism over sarcoma include: lack of vessel lumen expansion beyond normal caliber, documented DVT or known thromboembolic risk factors, and response to thrombolytic or anticoagulation therapy with interval shrinkage of the filling defect. Pathologic canalization of thrombus on follow-up confirms thrombotic rather than neoplastic etiology.
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