naa a22 4500 510747957 CHVBK 20180411083053.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s11547-013-0943-x doi (NATIONALLICENCE)springer-10.1007/s11547-013-0943-x Pulmonary artery intimal sarcoma. Problems in the differential diagnosis [Elektronische Daten] [Domenico Attinà, Fabio Niro, Patrick Tchouanté, Giangaspare Mineo, Vincenzo Russo, Massimiliano Palazzini, Nazzareno Galiè, Stefano Fanti, Luigi Lovato, Maurizio Zompatori] I sarcomi intimali dell'arteria polmonare. Problemi di diagnosi differenziale Purpose: Pulmonary artery sarcomas (PAS) are rare malignant tumours that originate from the intimal layer of the pulmonary artery, occur in middle age and have a poor prognosis. In planning appropriate treatment, malignant disease should be suspected whenever there are specific clinical and radiological manifestations, in order to establish the differential diagnosis with acute pulmonary embolism or chronic thromboembolic pulmonary hypertension, with which this malignancy is most commonly confused. Materials and methods: Between 2008 and 2012, we managed four adult patients with a nonspecific clinical presentation who, at the conclusion of the diagnostic process, were found to be affected by PAS. Because of the initial suspicion of pulmonary embolism, all patients underwent chest radiograph, lung perfusion scintigraphy, trans-oesophageal echocardiography, and computed tomography (CT) angiography of the chest. Then, because of the peculiar CT findings and lack of response to anticoagulation therapy, a clinical suspicion of PAS was considered and all patients underwent positron-emission tomography (PET)-CT, and one patient also magnetic resonance imaging (MRI) of the chest. Subsequently, all patients underwent thromboendoarterectomy with histological investigation of the surgical specimen, which confirmed the clinical and radiological suspicion of PAS. Results: CT is the technique that enabled the first step in the differential diagnosis between PAS and pulmonary embolism. The CT characteristics suggestive of PAS included the particular filling defect occupying the entire lumen of the pulmonary trunk with increase in diameter of the involved vessel and patchy and delayed contrast enhancement at CT angiography, more evident in the venous phase. PET-CT was used to differentiate between PAS and pulmonary embolism on the basis of the intensity of increased radiopharmaceutical uptake. MRI was used in one case of equivocal results on PET-CT, to improve tissue characterisation of the lesions and differentiation between the thrombotic and neoplastic components. Conclusions: The radiologist is usually the first to raise a suspicion of PAS in patients with severe dyspnoea and filling defect in the pulmonary artery, unresponsive to anticoagulation therapy. Combining CT and PET-CT proved to be extremely useful in assessing patients with suspected PAS. Early diagnosis with the help of integrated imaging remains today the main direction to pursue in order to obtain improvements in prognosis. Springer-Verlag, 2013 Pulmonary artery sarcoma nationallicence Differential diagnosis nationallicence Computed tomography nationallicence Magnetic resonance imaging nationallicence Positron emission tomography nationallicence Sarcoma arteria polmonare nationallicence Diagnosi differenziale nationallicence Tomografia computerizzata nationallicence Risonanza magnetica nationallicence Tomografia ad emissione positroni nationallicence Attinà Domenico U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut Niro Fabio U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut Tchouanté Patrick U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut Mineo Giangaspare U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut Russo Vincenzo U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut Palazzini Massimiliano U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut Galiè Nazzareno U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut Fanti Stefano U.O. Medicina Nucleare, Dipartimento di Ematologia e Scienze Oncologiche, Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut Lovato Luigi U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut Zompatori Maurizio U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut La radiologia medica Springer-Verlag 118/8(2013-12-01), 1259-1268 0033-8362 118:8<1259 2013 118 11547 https://doi.org/10.1007/s11547-013-0943-x text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11547-013-0943-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Attinà Domenico U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut NATIONALLICENCE 700 1- Niro Fabio U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut NATIONALLICENCE 700 1- Tchouanté Patrick U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut NATIONALLICENCE 700 1- Mineo Giangaspare U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut NATIONALLICENCE 700 1- Russo Vincenzo U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut NATIONALLICENCE 700 1- Palazzini Massimiliano U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut NATIONALLICENCE 700 1- Galiè Nazzareno U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut NATIONALLICENCE 700 1- Fanti Stefano U.O. Medicina Nucleare, Dipartimento di Ematologia e Scienze Oncologiche, Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut NATIONALLICENCE 700 1- Lovato Luigi U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut NATIONALLICENCE 700 1- Zompatori Maurizio U.O. Radiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti 9, 40128, Bologna, Italy aut NATIONALLICENCE 773 0- La radiologia medica Springer-Verlag 118/8(2013-12-01), 1259-1268 0033-8362 118:8<1259 2013 118 11547 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer