Pulmonary artery sarcoma mimicking PE: BMJ case report
A 62-year-old woman with diabetes presented with progressive exertional dyspnoea, chest pain and palpitation for several months. She had no history of leg oedema, fever, bodyweight change and general weakness. Therefore, she received associated exams at cardiovascular outpatient department.

Transthoracic echocardiogram showed right atrium and ventricle dilatation with severe pulmonary hypertension. Besides, a thrombus-like mobile mass was noted at right ventricle and pulmonary artery (figure 1, video 1).

Pulmonary embolism, as one of the life-threatening conditions, was the tentative diagnosis, and she was transferred to the emergency department. Chest CT revealed multifocal filling defects at right ventricle, main pulmonary artery trunk and bilateral pulmonary arteries with several lung nodules.

Primary tumour or metastasis was the final impression by image study. Finally, the patient underwent surgery, which confirmed the mass to be pulmonary artery intimal sarcoma, not a large thrombus.

Learning points
• The diagnosis of pulmonary artery sarcoma should be considered in patients who present with pulmonary embolism, especially poor response to anticoagulant therapy.

• Thrombus and mass are difficult to differentiate, even with transthoracic echocardiogram and chest CT.

• Team work should be organised for final diagnosis, involving echo specialist, cardiovascular surgeon and radiologist.

Read more here: http://casereports.bmj.com/content/2018/bcr-2018-226999.full
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