Liposarcoma presenting as a pulmonary embolism with right-si
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Case Summary
A 46-year-old man with a history of liposarcoma presented to the radiology department for an outpatient contrast-enhanced chest CT after reporting to the primary care provider that he had become increasingly short of breath over the past several weeks. Over the past five days he had become acutely more dyspneic. He reported difficulty with daily activities, such as walking and exercising. He denied any changes in symptoms with position or environment. He denied any chest pain, weight gain or swelling, cough, hemoptysis, or dizziness. His review of systems was otherwise negative. He denied any alcohol, tobacco, or illicit drug use.

IMAGING FINDINGS

Upon presenting to the imaging center, he received a standard bolus of contrast for performance of the chest CT for concern for pulmonary embolism. Upon completion of the CT, the radiologist saw a large hypoattenuating filling defect within the main pulmonary artery and extending into the right pulmonary artery branch. The defect appeared to extend into the pulmonary outflow tract in the right ventricle (Figures 1-3). The pulmonary artery was dilated and measured 4.2 cm compared to the adjacent ascending aorta, which measured 3.8 cm. The filling defect measured in the range of -6 to 16 Hounsfield units, atypical for thrombus. There was flattening of the interventricular septum with enlargement of the right atrium (Figure 4). There was reflux of contrast into the hepatic veins and IVC consistent with elevated right-sided cardiac filling pressures.

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