Pulmonary artery intimal sarcoma is a rare highly lethal disease, with additional retrograde extension to pulmonic valve and right ventricle being an extremely rare condition. It is frequently mistaken for pulmonary thromboembolism. We report a case of 64-year-old woman with progressive dyspnea initially suspected and treated for pulmonary thromboembolism. Her helical chest CT scan with 3 dimensional (3D) reconstruction combined with echocardiography revealed a compacting main pulmonary artery mass extending to the right ventricular outflow tract and the right pulmonary artery. After excision of the mass, the patient's condition improved dramatically, and the pathologic findings revealed pulmonary intimal sarcoma. This report emphasizes that helical chest CT with 3D reconstruction can be an important tool to differentiate the characteristics of pulmonary artery lesions, such as intimal sarcoma and thromboembolism.
Diagnosis, Differential ; Echocardiography ; Female ; Human ; Imaging, Three-Dimensional ; Middle Aged ; Pulmonary Artery/pathology/*radiography ; Sarcoma/pathology/*radiography/ultrasonography ; Tomography, X-Ray Computed/*methods ; Tunica Intima/pathology/radiography ; Vascular Neoplasms/pathology/*radiography/ultrasonography

BACKGROUND/AIMS: Recent intravascular ultrasound (IVUS) studies of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) have demonstrated a significant reduction in neointimal hyperplasia (NIH) based on simple coronary lesions. In this study, we evaluated the efficacy of SES and PES using IVUS in complex coronary lesions. METHODS: Eighty-seven patients in whom 95 drug-eluting stents (66 SES and 29 PES) were implanted in complex coronary lesions were enrolled in this study. Case selection was based on the availability of IVUS and quantitative coronary angiographic (QCA) examinations at the index procedure and at follow-up. The neointimal volume index (volume/length: NIVI) and percent neointimal volume (% NIV) were calculated. The longitudinal length of stented segments without IVUS-detectable NIH was also evaluated. RESULTS: The baseline patient demographics were similar between the SES and PES groups. At follow-up, no significant differences were observed in the vessel, plaque, or stent volume indices between the two groups. However, the NIVI and % NIV were significantly lower in the SES group (p<0.01). The longitudinal length of stented segments without IVUS-detectable NIH was significantly higher in the SES group (p<0.01). The net gain was significantly larger in the SES group (2.3+/-0.7 vs. 2.0x0.6 mm, p=0.025), while the rate of major adverse cardiac events was similar between the two groups. CONCLUSIONS: Although SES showed significantly greater suppression of NIH at follow-up, both stents were highly effective at inhibiting NIH in complex coronary lesions.
Adult ; Aged ; Coronary Angiography ; Coronary Artery Disease/radiography/*therapy/ultrasonography ; *Drug-Eluting Stents/adverse effects ; Female ; Follow-Up Studies ; Humans ; Hyperplasia ; Male ; Middle Aged ; Paclitaxel/*administration & dosage ; Sirolimus/*administration & dosage ; Tunica Intima/pathology ; Ultrasonography, Interventional/*methods