Massive Pulmonary Artery Research Articles

Pulmonary artery mass with PIK3CA mutation after orthotopic heart transplantation

BackgroundPatients can develop de novo malignancies following orthotopic heart transplantation. However, vascular tumors are not commonly described in this population.Case presentationWe present a 69-year-old female with a history of orthotopic heart transplantation for chemotherapy-induced cardiomyopathy who developed an incidental pulmonary artery mass six years after her transplantation. Given concerns for malignancy, the patient underwent an operative excisional biopsy through a left anterior mini-thoracotomy with femoral artery and vein cannulation for cardiopulmonary bypass. The mass was determined to be a non-malignant vascular overgrowth with PIK3CA mutation.ConclusionWe present the case of an unusual pulmonary artery mass with PIK3CA mutation found in a post heart transplant patient. We were able to spare her the morbidity of a redo-sternotomy by excising the mass via a minimally invasive left anterior thoracotomy approach.

Massive right pulmonary artery to superior vena cava shunt following extracorporeal membrane oxygenation.

Massive right pulmonary artery to superior vena cava shunt following extracorporeal membrane oxygenation.

A primary pulmonary artery sarcoma masquerading pulmonary embolism: a case report and literature review

BackgroundPrimary pulmonary artery sarcoma (PAS) is an extremely rare malignant tumor with a poor prognosis. The clinical manifestations of PAS are diverse, including dyspnea, chest pain, cough, and hemoptysis. The poor prognosis is often due to delayed diagnosis caused by similarity in imaging findings with pulmonary thromboembolism (PTE). These cues of diagnosis include the “wall eclipsing sign”, lobulated bulging margins, gadolinium enhancement during MRI imaging, and FDG uptake during PET/CT imaging. However, there are still many misdiagnoses.Case presentationThis article reports a woman of reproductive age presenting with a pulmonary artery mass. The computed tomographic pulmonary angiography and positron emission tomography/computed tomography did not show obvious signs of pulmonary artery sarcoma, however, contrast-enhanced echocardiography showed moderate perfusion, which helped differentiate between pulmonary artery sarcoma and pulmonary artery thrombosis, leading to timely surgical treatment.ConclusionsPAS is a rare form of cancer that can occasionally be visually similar to PTE on radiographic images. Early diagnosis of PAS is of vital importance to the prognosis of the patients. There are several visual cues that can help differentiate between the two conditions. Additionally, contrast-enhanced echocardiography provides additional information on tumor perfusion, offering another effective approach for a prompt and accurate diagnosis.

Massive Pulmonary Artery Aneurysm in a Patient with Ventricular Septal Defect: Case Report of a Rare Association

A pulmonary artery aneurysm is defined as focal dilation of the pulmonary artery beyond a diameter of 29 mm. The reported incidence is 1 in 14,000 as per the autopsy studies. A diameter of more than 55 mm is defined as a massive pulmonary artery aneurysm which is very rare. These are commonly associated with patent ductus arteriosus. No distinct features for identification and guidelines for their management warrant a detailed evaluation for etiology and close follow-up in this entity fearing fatal rupture. We present a case of a massive pulmonary artery aneurysm associated with the ventricular septal defect.

Anesthetic Management of a Case of Airway Bleeding During Pulmonary Artery Mass Resection

Airway bleeding is an uncommon complication of pulmonary artery surgery. It can be caused by fragile bronchopulmonary collateral, vessel perforation, and reperfusion pulmonary edema. Early discovery of the breach and anesthetic management are very important for the prognosis of the patients. We present a case of 58-year-old female diagnosed with left pulmonary artery mass. After the resection of the mass, the surgeon injected saline into the pulmonary artery and the patient was ventilated manually. Air bubbles were found in the artery, indicating a breach between the airways and the pulmonary circulation. Fiberoptic bronchoscopy revealed the breach on the lateral wall of the left lower bronchus. We replaced the single lumen endotracheal tube with a 32 left-sided double-lumen endobronchial tube to prevent the contamination of the right lung. After a consultation with the thoracic department, left lower lung lobectomy was performed.

Enormous Pulmonary Arteries and a Late Diagnosis of a Common Congenital Cardiac Issue: A Case Report

Background: Noonan’s syndrome is the second most common congenital cardiac syndrome after Down syndrome. Classically it is associated with pulmonary stenosis, Hypertrophic Cardiomyopathy (HCM), and Atrial Septal Defects (ASD). Late presentations, milder phenotypes and atypical presentations can occur in adult life and have cardiovascular implications. Case Summary: A 62-year-old presented to the emergency department with chest pain and atrial fibrillation with fast ventricular rate and RBBB morphology. A transthoracic echocardiogram demonstrated a massive Pulmonary Artery (PA), concerning for pulmonary hypertension and an atrial septal defect (ASD). Right heart catheterization indicated enormous coronary artery ectasia but normal PA pressures and wedge pressures. He was identified as a late presentation of Noonan’s syndrome on subsequent genetic testing. Discussion: Some series indicate a prevalence of 1 in 100 for mild Noonan’s syndrome phenotypes, highlighting the importance of understanding its cardiac presentations. In this case, we present a man with minimal symptoms but gross pathologies of his pulmonary and coronary arteries. Furthermore, pulmonary artery dilatation without pulmonary valve pathology has not been reported in the literature, and only a few reports of coronary artery ectasia are reported.

Massive Right Ventricular and Pulmonary Artery Emboli In-Transit after Cardiac Surgery: Consideration of Non-Surgical Treatment

Background:Pulmonary embolism (PE) is a complication of open-heart surgery that accounts for 0.6% of all cases and its mortality rate varies from 50% to 100%. Here, we describe a case of right ventricular and pulmonary artery emboli in-transit. Case report: A 56-year-old female presented with complain of dyspnea and palpitation and history of recent coronary artery bypass graft (CABG) surgery. Edema of the right leg was noted. Trans-esophageal echocardiography (TEE) performed and revealed severe tricuspid regurgitation due to stucking clot in tricuspid valve. A large clot in right ventricle (RV) and right ventricle outflow tract (RVOT) with the size of 55 × 13mm was noted. There was also a clot with the size of 22 × 10mm in right pulmonary artery (RPA). Early in the ICU, patient received 10 units (18mg) of reteplase (IV) over 2 minutes and then 10 units was given with the rate of 1mg/hour after the first dose, with 30 minutes intervals. IV Heparin (18mg/Kg/h) was also co-administered with reteplase.There was no visible clot in RV and pulmonary artery in follow-up echocardiography. Patient transferred to CCU with stable hemodynamics and finally discharged with normal condition. Discussion: Surgery is an alternative in patients with massive PE but our patient had a prior cardiac surgery which re-operation had a high risk for her. Due to massive in-transient emboli of right heart and PA in our patient, we decided to proceed the treatment with reteplase. The patient was monitored carefully for hemodynamics and coagulation parameters and she was discharged without any systemic complication.

Surgical correction of massive main pulmonary artery aneurysm due to giant cell arteritis causing left main coronary artery compression.

Surgical correction of massive main pulmonary artery aneurysm due to giant cell arteritis causing left main coronary artery compression.

Abstract P172: Pulmonary Valve Papillary Fibroelastoma In A Patient With Chronic Chest Pain

Primary cardiac tumors are rare entity, and the most common benign cardiac neoplasms include myxomas, lipomas and papillary fibroelastomas (PFE) with PFE accounting for 8% of the tumors. A 53-year-old female presented with chronic chest pain and exertional shortness of breath. She first sought evaluation four years ago, when her pulmonologist referred her to thoracic surgery after an incidental finding of a 3.9 cm anterior mediastinal mass on CT-scan (Figure 1A-B). The patient described the pain as a constant pressure and squeezing sensation in her chest and worsening shortness of breath while laying on her sides, relieved only when a pillow was propped up under her chest. The pain did not significantly reduce her mobility or capacity to work. Initial evaluation, including transthoracic echocardiogram, stress testing, carotid ultrasound, and pulmonary function testing - was performed and found to be unremarkable. Further evaluations revealed a hiatal hernia, leading her symptoms to be attributed to GERD as causing her persistent non-exertional chest pain. The patient remained in good health despite her symptoms persisting. She later re-sought attention for chest pain on exertion and hoarseness three years later. She again underwent a full cardiopulmonary workup, yielding benign findings on EKG, troponins, and echocardiogram. Due to no alarming symptoms at the time, she was subsequently discharged. The patient continued to endorse chest pain and a follow-up MRI revealed a now 5 cm anterior mediastinal mass, thought to be a thymic cyst. Over the next few months, the patient continued to endorse worsening chest pain and exertional shortness of breath. She followed up with her cardiologist and a subsequent TEE was significant for a pulmonic valvular mass. She was admitted to the hospital for further investigation. During her hospital stay, the patient underwent surgery to resect the anterior mediastinal mass likely to be a thymic cyst and the pulmonary artery mass which was determined to be a pulmonary valve papillary fibroelastoma in the histopathology exam (Figure 2). The surgery was successful with no complications postoperatively. The patient was discharged with no further chest pain and with improvement of the exertional shortness of breath.

Massive Pulmonary Artery Thromboembolism in a Liver Transplant Recipient: Case Study and Literature Review

The hypercoagulable state in liver transplant recipients that may manifest as abnormal thrombus formation in large vessel structures, such as cardiac chambers and the pulmonary arteries, poses a substantial threat for the patient and graft survival. Massive pulmonary embolism is a rare, albeit potentially lethal, complication that may occur at any stage of liver transplant surgery. In this study, we present the case of a major perioperative thromboembolic event in a liver transplant recipient that had taken place in the early post-transplant period during the second-look surgery that was then successfully treated by catheter-directed clot removal. We will attempt to identify potential factors that may have been associated with abnormal thrombus formation.

Pulmonary Artery Sarcoma Diagnosed Using an Endovascular Catheter Forceps Biopsy.

We herein report a case of pulmonary artery sarcoma (PAS) in a 64-year-old woman. She was admitted to our hospital because of massive genital bleeding from endometrial cancer. Contrast-enhanced computed tomography (CT) revealed a left pulmonary artery mass and deep vein thrombosis. She underwent anticoagulant therapy for one year. However, the mass lesion gradually expanded. 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT showed a positive uptake of FDG by the mass. An endovascular catheter biopsy was performed for the differentiation of endometrial cancer metastasis or primary sarcoma. The biopsy specimen tissue comprised spindle-shaped cells. Thus, the patient was diagnosed with PAS.

Rosai-Dorfman Disease Presenting as a Pulmonary Artery Mass on FDG PET/CT

Rosai-Dorfman disease (RDD) is an uncommon histiocytic disorder typically involving the lymph nodes and occasionally manifests as extranodal disease. Extranodal RDD involving pulmonary artery without lymphadenopathy or other extranodal lesions is very rare. We present the case of a 48-year-old woman complaining of shortness of breath on exertion for 6 months. F-FDG PET/CT revealed a pulmonary artery mass with intense FDG avidity. No other abnormal FDG-avid lesion was observed. The pulmonary artery mass was then surgically removed, and the pathological and immunohistochemical results confirmed RDD.

P1450 Pulmonary artery sarcoma mimicking as pulmonary thromboembolism for a young man: the role of multimodality imaging for diagnosis

Abstract Patient presentation A 33-year-old man was referred to our hospital suffering fever with shivers, dyspnea, dry cough, and weakness. Initial work up Symptoms appeared three weeks until hospitalization. Laboratory results showed leukocytosis and high levels of inflammatory markers. Haematological diseases were excluded, a chest x-ray showed infiltration in the lower lobe of the right lung, antibiotics were prescribed. Diagnosis and management When clinical and laboratory results showed no signs of improvement, chest computed tomography (CT) scan was performed and bilateral pulmonary artery thromboembolism with right lung infarct-pneumonia was diagnosed (Figure 1, 2). Treatment was supplemented with intravenous anticoagulants. In the course of treatment patient’s status worsened, respiratory failure progressed, so CT scan was performed again and showed massive pulmonary artery thromboembolism without the effect of treatment. Transthoracic 2D echocardiography showed dilated right heart chambers, relative severe tricuspid valve regurgitation, increased systolic pulmonary artery pressure (Video 1, figure 3), pulmonary artery valve masses in the stem which caused obstruction with maximum gradient about 50 mmHg(Video 2, figure 4). For a detailed workup, magnetic resonance imaging (MRI) was done, that revealed tumorous masses from pulmonary artery valve to the pulmonary trunk and right pulmonary branch (Figure 5, 6, 7). The patient underwent pulmoangiography and biopsy was taken out of the masses that suspected sarcoma. The multidisciplinary team came to a conclusion to perform surgery considering worsening patient’s status. The patient underwent pulmonary artery prosthesis implantation and right pneumonectomy (Figure 8). Masses from pulmonary artery valve were examined by pathologists, surgical specimen results showed high grade poorly differentiated pulmonary artery intimal sarcoma (Figure 9, 10). Follow up Early postoperative period was complicated with cardiogenic shock and respiratory failure. Despite extracorporeal membrane oxygenation (ECMO) and high doses of vasopressors patient did not survive the 2nd postoperative day. Conclusions Pulmonary artery sarcoma (PAS) frequently can be misdiagnosed as thromboembolism. Multimodality imaging should be considered pulmonary artery filling defects persist despite proper anticoagulation therapy for early diagnosis and better survival. Abstract P1450 Figure 3.

Irreversible Electroporation to Treat Unresectable Colorectal Liver Metastases (COLDFIRE-2): A Phase 2, Two-Center, Single-Arm Clinical Trial

Background: Irreversible electroporation (IRE), an ablative technique using high-voltage electrical pulses, has shown promise to eradicate tumors nearby critical structures like blood vessels and bile ducts. The aim was to investigate the efficacy and safety of IRE for colorectal liver metastases (CRLM) anatomically unsuitable for resection and thermal ablation. Methods: In this single-arm, two-center phase 2 clinical trial, patients with 18F-FDG PET-avid CRLM ≤5·0 cm unsuitable for partial hepatectomy and thermal ablation according to a multidisciplinary expert panel, were treated with IRE (ClinicalTrials.gov NCT02082782). For the primary endpoint to be met, at least 50% of treated patients had to be alive without local tumor progression (LTPFS) at 12 months. Secondary aims were safety, technical success, local control following repeat procedures, disease-free and overall survival. Findings: Between June 2014 and November 2018, 50/51 patients with a total of 76 CRLM were successfully treated with IRE in 62 procedures; in 1 patient treatment was stopped prematurely due to a pulsed-induced cardiac arrhythmia. With a per-patient and per-tumor 1-year LTPFS of 68·8% (95%-CI 55·4-81·4%) and 76·0% (95%-CI 64·8-85·8%) respectively, the primary endpoint was met. Including repeat procedures local control was realized in 74·0% (37/50) of patients. Local tumor progression in the first 5 versus the following 45 patients was 80% versus 33·3% (p=0·062). One patient, with an infected biloma post-IRE and an autopsy confirmed pre-existing cardiomyopathy, infected atrial thrombus, massive pulmonary artery embolism and acute myocardial infarction died <90 days (grade 5; 1·6%). Overall, 19 serious adverse events (SAE) were encountered (SAE rate 30·6%), of which 16 (25·8%) were grade 3 and 2 (3·2%) were grade 4. Interpretation: This trial supports the use of IRE for patients with CRLM ≤5·0 cm considered permanently unsuitable for partial hepatectomy and thermal ablation. Trial Registration: The trial was investigator-sponsored, independent of industry and registered at clinicaltrials.gov (NCT02082782). Funding Statement: Amsterdam UMC, Angiodynamics, Adessium Foundation. Declaration of Interests: MRM and KvL were paid consultants to Angiodynamics during the conduct of the study. MRM received an unrestricted research grant from Angiodynamics for a different project during the conduct of the study. All other authors declare no competing interests. Ethics Approval Statement: The study was approved by the Institutional Review Board of the Amsterdam UMC location VUmc. The trial was conducted in accordance with the Declaration of Helsinki. All patients provided written informed consent.

Massive Pulmonary Artery Dilatation in a Case of Chronic Thromboembolic Pulmonary Hypertension

Massive Pulmonary Artery Dilatation in a Case of Chronic Thromboembolic Pulmonary Hypertension

Massive Main Pulmonary Artery Aneurysm Complicated by Acute Dissection

Massive Main Pulmonary Artery Aneurysm Complicated by Acute Dissection

Successful ablation for pulmonary artery tumor thrombosis more than 5 cm with massive hepatocellular carcinoma and multiple pulmonary metastases

We presented a 72-year-old male patient with a massive pulmonary artery tumor thrombosis (PATT) of 5.8 cm in diameter originating from two huge unresectable hepatocellular carcinomas (HCC, 8.3 and 5.5 cm) and multiple pulmonary metastases (PM). The patient was treated by percutaneous thermal ablation, and complete response was achieved. No severe complication was found during the treatment course. After a 6-year follow-up period for the primary HCC and a 14-month follow-up period for the PATT, no tumor progression was identified. The relevant literatures were presented and discussed. In conclusion, percutaneous ablation was a safe and effective treatment of PATT, as well as advanced HCC.

Successful ablation for pulmonary artery tumor thrombosis more than 5 cm with massive hepatocellular carcinoma and multiple pulmonary metastases

: We presented a 72-year-old male patient with a massive pulmonary artery tumor thrombosis (PATT) of 5.8 cm in diameter originating from two huge unresectable hepatocellular carcinomas (HCC, 8.3 and 5.5 cm) and multiple pulmonary metastases (PM). The patient was treated by percutaneous thermal ablation, and complete response was achieved. No severe complication was found during the treatment course. After a 6-year follow-up period for the primary HCC and a 14-month follow-up period for the PATT, no tumor progression was identified. The relevant literatures were presented and discussed. In conclusion, percutaneous ablation was a safe and effective treatment of PATT, as well as advanced HCC.

Mass in Right Pulmonary Artery—Case Report

AbstractThe authors present a case of mass in the right pulmoary artery in a 60-year-old female patient who had dyspnea on exertion for 1 month before admission. Two-dimensional echocardiography and computed tomography pulmonary angiogram revealed mass in the right pulmonary artery. There was no evidence of deep venous thrombosis. Though the final diagnosis was not made, the authors present this case mainly for identifying and differentiating pulmonary artery thrombosis from chronic thromboembolic pulmonary hypertension and tumor.

A case of successful systemic thrombolysis in massive thromboembolia of pulmonary artery against the background of pregnancy

We present a clinical case of successful systemic thrombolysis in a pregnant patient with massive pulmonary embolism. A 29-year old patient at 28 weeks of pregnancy was hospitalized 2 hours after sudden suffocation in a presyncopal state and hypotension of 90/50 mm Hg. ECG showed the signs of overload of right heart chambers in the form of a typical S1-Q3-T3 (McGinn–White) syndrome, as well as the Kosuge sign. Echocardiography verified pulmonary 3 Grade hypertension (81 mm Hg), enlargement of the right atrium and ventricle, 3 Grade tricuspid regurgitation and paradoxical movement of the interventricular septum. Multislice computed tomography of the chest with contrast of the pulmonary artery revealed a defect of contrast in the right main pulmonary artery, occlusive clearance, and thrombotic mass, extending to the bifurcation of the left main pulmonary artery ("clot - rider"). Thrombolytic therapy was started with recombinant tissue plasminogen activator (alteplase 10 mg bolus, then 90 mg for 2 hours). The patient was daily examined by a gynecologist. The viability of the fetus, monitoring of possible hemorrhagic complications of the placenta were evaluated. After thrombolysis, the patient began to note clinical improvement in the form of a regression of dyspnea. According to echocardioscopy control, the signs of overload of right heart chambers completely regressed. There were no complications both in the mother and in the fetus during the subsequent days until discharge. On 25.05.16 there was uncomplicated delivery vaginally of live full-term girl. Thus, when there is life-threatening massive pulmonary embolism, the application of General principles of diagnosis and treatment of this disease in patients with pregnancy is warranted. The carrying out of thrombolytic therapy in massive pulmonary embolism enables to reduce the manifestations of pulmonary hypertension, right ventricular failure, and to conduct births on time. Used intravenous thrombolytics have no teratogenic effect in the later stages of pregnancy.Received 18 April 2017. Accepted 5 June 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.