Keywords:
Neoplasia, Diagnostic procedure, MR, CT-Angiography, Pulmonary vessels, Arteries / Aorta
Authors:
V. Alberotanza, R. Virelli, V. M. Rossano, M. C. rolli, P. Pignataro, P. Pedote, G. Berardi; Bari/IT
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 main pulmonary arteries in the female patient,
while in two cases localized focal thrombus below the origin of the right branch of the pulmonary artery.
In these three cases,
therefore,
anticoagulant therapy was established without significant results.
Transesophageal ultrasound confirmed presence of solid formation and a defect of filling of the arterial trunk.
In order to clarify the overall picture,
two of three patients underwent to cardiac MRI that showed solid tissue in T1 and T2 sequences,
with patchy impregnation of contrast medium.
There was a worsening of clinical conditions in the woman's patient,
absence of response to medical treatment and then was transferred to another hospital for pulmonary artery block replacement surgery.
The other two patients in stable clinical conditions were subjected to exeresis of arterial masses and reconstruction of the artery branch.
The patient undergoing emergency intervention for block replacement of the pulmonary artery died immediately after surgery; both two patients had no complications in postoperative.
Histological examination was performed and was poorly differentiated leiomyosarcoma in female patient and moderately differentiated in the remaining two patients.