CTICasesChronic Thromboembolic Disease with Clot Propagation Mimicking Sarcoma
Imaging findings
A pulmonary artery filling defect with a proximal sausage-shaped expansion initially suggested pulmonary artery sarcoma, but the distal vessel was contracted rather than expanded. Prior imaging showed an acute pulmonary embolism a year earlier that did not resolve, progressing to persistent occlusion of the lingular and left lower lobe vessels; the vessel contracted and clot propagated proximally into the sausage shape. After anticoagulation, most of the sausage disappeared, leaving an appearance of classic chronic thromboembolic disease.
Key takeaways
A proximal sausage-shaped expansion of a pulmonary artery can mimic pulmonary artery sarcoma but may instead be clot propagating onto a distally occluded vessel in chronic thromboembolic disease. A helpful discriminator is that sarcoma usually also expands the distal vessel, whereas the distal vessel is contracted here, and resolution on anticoagulation confirms bland thrombus.
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