Pulmonary artery sarcoma: Case report and review of the literature.
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ABSTRACT:
SUBMITTER: Moguillansky NI
PROVIDER: S-EPMC6538954 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:This is a case report of a 53-year-old woman who presented to our hospital in 2011 with an intermittent cough and dyspnea for 5 years. The chest X-ray showed a prominent left hilum and a smaller right lung. Computed tomography (CT) of the chest confirmed the absence of the right pulmonary artery (PA) and the right cardiac catheterization showed a mean PA pressure of 34 mmHg. Concomitant asthma and unilateral absence of pulmonary artery (UAPA) were diagnosed. In the following years, her functional class remained stable under medications including low-dose sildenafil and spironolactone. In 2020, she developed mild intermittent chest tightness and the coronary angiography showed a fistula between the proximal left circumflex coronary artery and right pulmonary circulation. She declined further intervention for her coronary-pulmonary artery fistula (CPAF) and her symptoms improved spontaneously. To our knowledge, only 16 similar cases with combined UAPA and CPAF in adults have been reported in the literature, of which, pulmonary hypertension was documented in nine patients (56.3%).
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Project description:Background:Misplacement of central venous catheters (CVC) may have devastating consequences. Patients and methods:Placement of a CVC into the pulmonary artery (PA) and management of the complication is described. Literature search for accidental direct placement of CVCs into the PA was performed. Results:A 46 year old morbidly obese female required an infusaport for chemotherapy. She was anaesthetized and placed in Trendelenburg. Three attempts to access the left subclavian vein (LSCV) using landmarks failed. In steeper Trendelenburg, a blood vessels was accessed. Non pulsatile dark blood was aspirated, a guidewire was easily advanced. Fluoroscopy projected the guidewire tip over the right atrium; infusaport placement was without difficulties. Postoperative chest x-ray showed the tube initially pointing caudally, then traversing the midline with the tip projecting over the right atrium. Emergent angiogram showed placement of the tube into the mainstem of the PA. The tube was removed; CT-angiogram showed no extravasation but a 3cm left mediastinal hematoma. Transfer to an ICU in a facility offering emergent cardiothoracic surgery was done. She remained stable, repeat CT-scan showed decreased hematoma size and she was retransferred. The infusaport was placed under ultrasound guidance into the left jugular vein. Six additional cases of direct puncture of the PA were reported; in all except one the LSCV had been targeted. No patient died directly from the complication, all catheters were removed, four patients required surgery or interventional procedures. Conclusions:Accidental placement of CVC s into the PA is a rare complication. The catheter should be removed. Patients should be urgently transferred to a center with access to interventional radiology and cardiothoracic surgery.
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Project description:RationaleCardiac primary spindle cell sarcoma is 1 of the rarest cardiac malignancies, with only a few cases reported so far. Herein, we reported a case of left atrial spindle cell sarcoma diagnosed and treated by a multidisciplinary approach, and retrospectively reviewed other reported cases.Patient concernsA 49-year-old woman presented to our hospital with 2 weeks of gradual onset of dyspnea on exertion, dry cough and subacute fever.DiagnosisThe patient was initially revealed a left atrium mass by 2-dimensional transthoracic echocardiography. Based on the contrast-enhanced echocardiography and cardiac magnetic resonance imaging, she was subsequently suggested to have a cardiac malignant tumor. And the post-operative histopathology confirmed the tumor to be a cardiac primary spindle cell sarcoma.InterventionsThe tumor was completely resected using autotransplantation. The patient was referred for polychemotherapy afterwards.OutcomesOur patient underwent the tumor resection, with subsequent adjuvant polychemotherapy, and the tumor has not recurred during 12 months of follow-up.LessonsDue to the rarity of these tumors and nonspecific symptoms, they are often difficult to diagnose preoperatively and missed occasionally. Thus, improving our understanding of the disease and facilitating its early diagnosis are essential.
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