Primary Intimal Pulmonary Vein Sarcoma with Expansion to the Left Atrium
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 2
Abstract
We have recently treated a patient with pulmonary vein sarcoma. It is a 65 year old women who was admitted to the hospital because of the chest pain with propagations down her right arm, followed by suffocation and coughing out content with traces of blood and febrility >38°C. The primarily suspected pulmonary embolism was ruled out after the diagnostic heart CT scan and transthoracal and transesophageal echocardiogram which verified the existing of a tumor mass in the left atrium. The patient underwent an urgent surgery and the tumor mass was removed surgically from the upper right pulmonary vein. The path histological diagnoses revealed pulmonary vein intimal sarcoma. Pulmonary vein intimal sarcoma is one of the rarest sarcoma subtypes. To our knowledge, there is only one published case of such pathology in the literature. We have recently treated a patient with pulmonary vein sarcoma. It is a 65 year old women who was admitted to the hospital because of the chest pain with propagations down her right arm, followed by suffocation and coughing out content with traces of blood and febrility >38°C. The primarily suspected pulmonary embolism was ruled out after the diagnostic heart CT scan and transthoracal and transesophageal echocardiogram which verified the existing of a tumor mass in the left atrium. The patient underwent an urgent surgery and the tumor mass was removed surgically from the upper right pulmonary vein. The path histological diagnoses revealed pulmonary vein intimal sarcoma. Pulmonary vein intimal sarcoma is one of the rarest sarcoma subtypes. To our knowledge, there is only one published case of such pathology in the literature. A 65 year old female patient was admitted in the Emergency Room of Montenegrin Clinical Hospital because of the chest pain with propagations down her right arm, followed by suffocation and coughing out content with traces of blood and febrility >38°C. She mentioned the poor physical exercise tolerance with occasional swelling of lower extremities. She was experiencing the discomforts for the previous 10 days [1-3]. The patient had been a smoker for a long time. She was aware of cardiac arrhythmia which is why she had been prescribed an oral anticoagulant therapy. She had been aware of her condition of thrombocytopenia too. Twenty years ago she underwent hysterectomy with bilateral adnexectomy. During the physical examination the patient was eupnotic while resting, acyanotic, anicteric and afebrile. Her vital signs were: cardiac frequency (FR) 85/min, blood pressure (TA) 100/60 mmHg, respiratory frequency (FR) around 16-18/min, saturation (SO2) around 96%. Pulmonary auscultation revealed a weakened basal respiratory wheeze with sporadic late inspiratory bilateral basal crackles [4-7]. The auscultation also showed a rhythmical cardiac activity with clear tones and without wheezes. The extremities were without edemas, varicosity or deformities. EKG showed the sinus rhythm of around 85/min, normogram, without signs of ischemia. Se 30...72, CRP 10...160, D-dimer 0,73, PV 14,2, INR 1,2, fibrinogen 81, Le 5,74, Er 3,96, Hgb 122, HCT 0,35, Tr 162. Pulmonary X- ray showed left basal pleural pericardial effusion. Chest CT scan describes a 35 mm thrombus in the main part of Art. Pulmonalis which extends to the branch for the upper lobe with consequential parenchyma consolidation ventrally bigger than 50 mm, pericardially along with the pericardium almost completely occupying the front FC sinus and dorsally with the lower branch of interlobar incisura up to 30 mm and medially almost at the very top of the lungs with the size of up to 20 mm with the complete hypo perfusion of the upper lobe with evidently positive air bronchogram. Heart CT scan describes in the left atrium a big tumor-like change with the dimensions of 32x24mm, 32 mm long along which thrombotic masses are evident. The tumor covers both lower left pulmonary veins which are dilated and filled with thrombotic masses. Mediastinum contains numerous vein blood vessels which can correspond to obstructing changes at the level of azygos system. Right ventricle is of borderline size, the right ventricular outflow tract is preserved. The signs of pulmonary artery dilatation are evident without any presence of thrombosis. Under the left ventricle an isolated pericardial effusion can be seen in the pericardium. In pleura’s posterobasal and anterobasal segments the evidence of atelectasis are evident till the lower lingual. Both apical and lingular segments are peripherally sub-atelectatic. Left basal pleural effusion is also evident.
Authors and Affiliations
Aleksandar Nikolić
Keywords
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- EP ID EP567233
- DOI 10.26717/BJSTR.2017.01.000201
- Views 199
- Downloads 0
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