Purpose
Demonstrate the difficulty of diagnostic and therapeutic management in three cases of pulmonary ArteryLeiomyosarcoma.
Methods and Materials
Retrospective study analyzing,
from 2000 to 2017,
all patients with pulmonary artery leiomyosarcoma observed at single center.
Three patients,
two males and one female respectively 75,
80 and 73 years,
were admitted to the hospital for increasingly dyspnea.
The three patients underwent laboratory tests,
hemogasanalysis,
and ECG in emergency room.
Patients underwent to transthoracic echocardiography; CT of Pulmonary artery; Transesophageal ultrasound; and in two of three patients cardiac MRI.
Results
In all cases the hemogasanalysis showed hypoxia,
hypocapnia and mild respiratory alkalosis.
Laboratory examinations were aspecific: mild leukocytosis,
increased ESR,
cardiac enzyme negativity,
increased d-dimer and consumptive coagulopathy.
ECG showed sinusal tachycardia.
Transthoracic echocardiography showed the presence of a pulmonary artery thrombus in the three cases,
with a significant reduction in flow and a dilatation of the right ventricle.
In the three cases,
the pulmonary thromboembolism (PTE) was confirmed by CT,
which showed a lack of filling of the pulmonary trunk extended to the two...
Conclusion
Pulmonary Artery Leiomyosarcoma is a very rare neoplastic disease that simulates a PTE; ECHO and CT have shown themselves inadequate in diagnosing this pathology while cardiac MRI has allowed to exclude a PTE and to diagnose solid lesion.
The lack of response to conservative therapy,
the atypicalness of the radiological framework,
should cause suspect of this disease.
Diagnosis in the shortest possible time is necessary because the surgical treatment,
especially in the case with extended lesions,
must be early.
Personal Information
Vito Alberotanza
Azienda Ospedaliero-Universitaria Consorziale Policlinico - Bari
U.O.C.
Radiodiagnostica Universitaria
[email protected]
+39805478840