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High-grade, nonmyogenic pulmonary artery sarcoma: rare findings on coronary angiography.

ABSTRACT: Pulmonary artery sarcomas are exceptionally rare, and they are often misdiagnosed as chronic pulmonary thromboemboli. Early and accurate diagnosis is crucial to the prognosis of patients who have pulmonary artery sarcomas.Herein, we describe the case of a 74-year-old man who presented with dyspnea and was initially thought to have a pulmonary embolus. Anticoagulation with unfractionated heparin was ineffective. Rare angiographic findings during routine cardiac catheterization led to the diagnosis of a high-grade, nonmyogenic, primary pulmonary artery sarcoma. This case illustrates the usefulness of angiographic findings as an adjunct to conventional diagnostic methods in correctly identifying this rare, aggressive malignancy.

SUBMITTER: Ramjee V

PROVIDER: S-EPMC3060735 | biostudies-literature | 2011

REPOSITORIES: biostudies-literature

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High-grade, nonmyogenic pulmonary artery sarcoma: rare findings on coronary angiography.

Ramjee Vimal V Lewis Melinda M MM Clements Stephen D SD

Texas Heart Institute journal 20110101 1

Pulmonary artery sarcomas are exceptionally rare, and they are often misdiagnosed as chronic pulmonary thromboemboli. Early and accurate diagnosis is crucial to the prognosis of patients who have pulmonary artery sarcomas.Herein, we describe the case of a 74-year-old man who presented with dyspnea and was initially thought to have a pulmonary embolus. Anticoagulation with unfractionated heparin was ineffective. Rare angiographic findings during routine cardiac catheterization led to the diagnosi ...[more]

PMID: 21423475

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Project description:BackgroundTo analyze the imaging features of coronary artery-to-pulmonary artery fistula (CPAF) on coronary computed tomography angiography (CCTA).MethodsThis was a retrospective study of 3,975 patients who underwent 320 row detector CCTA examinations in our hospital from May 2015 to July 2020. A total of 22 patients who diagnosed with CPAF were reviewed for CCTA imaging characteristics, including the origin, number, blood volume, opening size, and course of fistula vessels, and the drainage site, size, and imaging features of the fistula. All cases were analyzed for the presence of coronary atherosclerotic plaque and that of deficient left ventricular myocardial perfusion.ResultsA total of 22 CPAF cases detected by CCTA were collected (men, 11; women, 11; median age, 59.6±10.1 years). There were 7, 10, and 5 cases detected with 1, 2, and 3 fistula vessels, respectively, among which 4 originated from the left coronary artery, 4 from the right coronary artery, and 14 had bilateral origins. There were 10 cases in which the fistula vessels presented as a worm-like tortuous dilation with (n=5) or without (n=5) aneurysm, while 12 cases showed malformed vascular networks with (n=8) or without (n=4) aneurysm, respectively. The calculated incidence of aneurysm formation was 59.09%, and fistula vessels with an aneurysm had larger blood volume than those without. All fistula showed a single drainage site, with an average diameter of 2.81±1.48 mm where the diameter of fistula with aneurysm was larger than that without. The fistula vessels drained into the left anterolateral and anterior walls of main pulmonary artery and the proximal left inferior PA, respectively. Typical jet sign, smoke sign, and isodensity sign were presented in 22, 14 and 1 case, respectively. For the coexistent abnormalities analyzed in 22 cases, 17 participants with CPAF demonstrated hypoperfusion of the fistula vessels, and 11 demonstrated calcified plaque accompanied with luminal stenosis to different degrees.ConclusionsThe 320-row detector CCTA can comprehensively characterize the morphological features of CPAF, which is an optimal choice for physicians to make an accurate assessment before formulating patient management strategies.

Project description:ObjectivesTo compare the detection of relevant extracardiac findings (ECFs) on coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA) and evaluate the potential clinical benefit of their detection.MethodsThis is the prespecified subanalysis of ECFs in patients presenting with a clinical indication for ICA based on atypical angina and suspected coronary artery disease (CAD) included in the prospective single-center randomized controlled Coronary Artery Disease Management (CAD-Man) study. ECFs requiring immediate therapy and/or further workup including additional imaging were defined as clinically relevant. We evaluated the scope of ECFs in 329 patients and analyzed the potential clinical benefit of their detection.ResultsECFs were detected in 107 of 329 patients (32.5%; CTA: 101/167, 60.5%; ICA: 6/162, 3.7%; p < .001). Fifty-nine patients had clinically relevant ECFs (17.9%; CTA: 55/167, 32.9%; ICA: 4/162, 2.5%; p < .001). In the CTA group, ECFs potentially explained atypical chest pain in 13 of 101 patients with ECFs (12.9%). After initiation of therapy, chest pain improved in 4 (4.0%) and resolved in 7 patients (6.9%). Follow-up imaging was recommended in 33 (10.0%; CTA: 30/167, 18.0%; ICA: 3/162, 1.9%) and additional clinic consultation in 26 patients (7.9%; CTA: 25/167, 15.0%; ICA: 1/162, 0.6%). Malignancy was newly diagnosed in one patient (0.3%; CTA: 1/167, 0.6%; ICA: 0).ConclusionsIn this randomized study, CTA but not ICA detected clinically relevant ECFs that may point to possible other causes of chest pain in patients without CAD. Thus, CTA might preclude the need for ICA in those patients.Trial registrationNCT Unique ID: 00844220 KEY POINTS: • CTA detects ten times more clinically relevant ECFs than ICA. • Actionable clinically relevant ECFs affect patient management and therapy and may thus improve chest pain. • Detection of ECFs explaining chest pain on CTA might preclude the need for performing ICA.

Project description:PurposeConventional CT technology yields only modest accuracy of coronary artery stenosis assessment in severely calcified lesions. Reported herein are this study's initial observations on the potential of ultra-high-resolution CT (UHR-CT) for evaluating severely calcified coronary arterial lesions.Materials and methodsFifteen patients 45 years of age or older, with history of coronary artery disease, referred for invasive coronary angiography, were prospectively enrolled. Patients underwent UHR-CT within 30 days prior to cardiac catheterization. Image noise levels and diagnostic confidence (level 1-5) using UHR-CT were compared with reconstructed images simulating conventional CT technology. Stenosis assessment for the major coronary arteries and the left main coronary artery with UHR-CT and invasive angiography were compared. Results from clinically driven coronary CT using conventional technology were considered for comparison when available.ResultsMean patient age was 67 years (range, 53-79 years). Thirteen patients were men, nine had obesity. Radiation dose was 9.3 mSv owing to expanded x-ray exposure to accommodate research software application (70%-99% of R-R cycle). Overall image noise was considerably greater for UHR-CT (50.9 ± 7.8 [standard deviation]) versus conventional CT image reconstruction (19.5 ± 8.3, P < .01), yet diagnostic confidence scores for UHR-CT were high (4.3 ± 0.9). Average calcium score in patients without stents (n = 6) was 1205, and of 86 vessels evaluated, 22 had 70% or greater stenosis depicted with invasive angiography (26%). Stenosis comparison with invasive angiography yielded 86% (19 of 22) sensitivity and 88% (56 of 64) specificity (95% CI: 65%, 97%; and 77%, 95%, respectively).ConclusionInitial observations suggest UHR-CT may be effective in overcoming the limitation of conventional CT for accurately evaluating coronary artery stenoses in severely calcified vessels.Keywords: CT-Angiography, Coronary Arteries, ArteriosclerosisClinical trial registration no. NCT04272060See also commentary by Shanbhag and Chen in this issue.© RSNA, 2021.

Dataset Information

High-grade, nonmyogenic pulmonary artery sarcoma: rare findings on coronary angiography.

Publications

High-grade, nonmyogenic pulmonary artery sarcoma: rare findings on coronary angiography.

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