Journal of Yeungnam Medical Science

영남대 의대 학술지 편집위원회 (Yeungnam University College of Medicine, Yeungnam University Institute Medical Science)
권호 표지
DOI QR코드

DOI QR Code

18F-FDG PET/CT를 통해 진단된 주폐동맥 협착 소견의 폐동맥 육종

Pulmonary artery sarcoma manifesting as a main pulmonary artery stenosis diagnosed by 18F-FDG PET/CT

  • 이훈희 (울산대학교 의과대학 서울아산병원 내과) ;
  • 박한빛 (울산대학교 의과대학 서울아산병원 내과) ;
  • 조윤경 (울산대학교 의과대학 서울아산병원 내과) ;
  • 안정민 (울산대학교 의과대학 서울아산병원 심장내과) ;
  • 이상민 (울산대학교 의과대학 서울아산병원 영상의학과) ;
  • 이재승 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김대희 (울산대학교 의과대학 서울아산병원 폐 고혈압 정맥혈전 센터)
  • Lee, Hoonhee (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Han-bit (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Cho, Yun Kyung (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ahn, Jung-Min (Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Sang Min (Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Jae Seung (Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Dae-Hee (Department of Pulmonary Hypertension and Venous Thrombosis Center, University of Ulsan College of Medicine, Asan Medical Center)
  • 투고 : 2016.07.08
  • 심사 : 2016.10.04
  • 발행 : 2017.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Pulmonary artery sarcoma (PAS) is a rare and fatal disease that often mimics chronic thromboembolic pulmonary hypertension (CTEPH); therefore, diagnosis of PAS is often delayed. Herein, a healthy 74-year-old man was presented with a 4-month history of dyspnea. Chest computed tomography showed wall thickening and stenosis in the main pulmonary artery as well as in both proximal pulmonary arteries. In order to differentiate between unusual CTEPH, vasculitis, and PAS, we performed right heart catheterization and pulmonary angiography. The mean pulmonary arterial pressure was 21 mmHg, and there was severe pulmonary artery stenosis. Thrombi on the pulmonary arterial wall lesions were observed in intravascular ultrasound and optical coherence tomography. Furthermore, the patient had a history of deep vein thrombosis. Therefore, we diagnosed unusual CTEPH. After 6 months of rivaroxaban anticoagulation therapy, a chest X-ray revealed a left lower lobe lung mass, and a positron emission tomography later showed hypermetabolic lesions in the main pulmonary artery wall, in both pulmonary arteries walls, in the lung parenchyma, and in the bones. A biopsy of the right proximal humerus lesion revealed undifferentiated intimal sarcoma. Pulmonary sarcoma is rare, but should be considered when differentially diagnosing main pulmonary artery wall thickening and stenosis. A positron emission tomography may aid in this diagnosis.

키워드

참고문헌

  1. Blackmon SH, Rice DC, Correa AM, Mehran R, Putnam JB, Smythe WR, et al. Management of primary pulmonary artery sarcomas. Ann Thorac Surg 2009;87:977-84. https://doi.org/10.1016/j.athoracsur.2008.08.018
  2. Mussot S, Ghigna MR, Mercier O, Fabre D, Fadel E, Le Cesne A, et al. Retrospective institutional study of 31 patients treated for pulmonary artery sarcoma. Eur J Cardiothorac Surg 2013;43:787-93. https://doi.org/10.1093/ejcts/ezs387
  3. Weinstein JB, Aronberg DJ, Sagel SS. CT of fibrosing mediastinitis:findings and their utility. AJR Am J Roentgenol 1983;141:247-51. https://doi.org/10.2214/ajr.141.2.247
  4. Okano Y, Satoh T, Tatewaki T, Kunieda T, Fukuyama S, Miyazaki N, et al. Pulmonary artery sarcoma diagnosed using intravascular ultrasound images. Thorax 1999;54:748-9. https://doi.org/10.1136/thx.54.8.748
  5. Tatebe S, Fukumoto Y, Sugimura K, Nakano M, Miyamichi S, Satoh K, et al. Optical coherence tomography as a novel diagnostic tool for distal type chronic thromboembolic pulmonary hypertension. Circ J 2010;74:1742-4. https://doi.org/10.1253/circj.CJ-10-0160
  6. Wong HH, Gounaris I, McCormack A, Berman M, Davidson D, Horan G, et al. Presentation and management of pulmonary artery sarcoma. Clin Sarcoma Res 2015;5:3. https://doi.org/10.1186/s13569-014-0019-2
  7. Yi CA, Lee KS, Choe YH, Han D, Kwon OJ, Kim S. Computed tomography in pulmonary artery sarcoma: distinguishing features from pulmonary embolic disease. J Comput Assist Tomogr 2004;28:34-9. https://doi.org/10.1097/00004728-200401000-00005
  8. Chang S, Hur J, Im DJ, Suh YJ, Hong YJ, Lee HJ, et al. Dual-energy CT-based iodine quantification for differentiating pulmonary artery sarcoma from pulmonary thromboembolism:a pilot study. Eur Radiol 2016;26:3162-70 https://doi.org/10.1007/s00330-015-4140-2
  9. Hariri LP, Mino-Kenudson M, Lanuti M, Miller AJ, Mark EJ, Suter MJ. Diagnosing lung carcinomas with optical cohe0 rence tomography. Ann Am Thorac Soc 2015;12:193-201. https://doi.org/10.1513/AnnalsATS.201408-370OC
  10. Jiang X, Peng FH, Liu QQ, Zhao QH, He J, Jiang R, et al. Optical coherence tomography for hypertensive pulmonary vasculature. Int J Cardiol 2016;222:494-8. https://doi.org/10.1016/j.ijcard.2016.07.215
  11. Jorge E, Baptista R, Calisto J, Faria H, Monteiro P, Pan M, et al. Optical coherence tomography of the pulmonary arteries:a systematic review. J Cardiol 2016;67:6-14. https://doi.org/10.1016/j.jjcc.2015.09.024
  12. Li N, Zhang S, Hou J, Jang IK, Yu B. Assessment of pulmonary artery morphology by optical coherence tomography. Heart Lung Circ 2012;21:778-81. https://doi.org/10.1016/j.hlc.2012.07.014
  13. Lee EJ, Moon SH, Choi JY, Lee KS, Choi YS, Choe YS, et al. Usefulness of fluorodeoxyglucose positron emission tomography in malignancy of pulmonary artery mimicking pulmonary embolism. ANZ J Surg 2013;83:342-7. https://doi.org/10.1111/j.1445-2197.2012.06205.x
  14. Ito K, Kubota K, Morooka M, Shida Y, Hasuo K, Endo H, et al. Diagnostic usefulness of 18F-FDG PET/CT in the differentiation of pulmonary artery sarcoma and pulmonary embolism. Ann Nucl Med 2009;23:671-6. https://doi.org/10.1007/s12149-009-0292-y