000			03335nam a22003737a 4500
008			190314s20152015 xxu||||| |||| 00| 0 eng d
022			_a2000-9666
024			_a10.3402/jchimp.v5.29624 [doi]
024			_a29624 [pii]
024			_aPMC4677584 [pmc]
040			_aOvid MEDLINE(R)
099			_a26653696
245			_aWhen a pulmonary embolism is not a pulmonary embolism: a rare case of primary pulmonary leiomyosarcoma.
251			_aJournal of Community Hospital Internal Medicine Perspectives. 5(6):29624, 2015.
252			_aJ Community Hosp Intern Med Perspect. 5(6):29624, 2015.
253			_aJournal of community hospital internal medicine perspectives
260			_c2015
260			_fFY2016
265			_sepublish
266			_d2019-03-14
520			_aArterial leiomyosarcomas account for up to 21% of vascular leiomyosarcomas, with 56% of arterial leiomyosarcomas occurring in the pulmonary artery. While isolated cases of primary pulmonary artery leiomyosarcoma document survival up to 36 months after treatment, these uncommon, aggressive tumors are highly lethal, with 1-year survival estimated at 20% from the onset of symptoms. We discuss a rare case of a pulmonary artery leiomyosarcoma that was originally diagnosed as a pulmonary embolism (PE). A 72-year-old Caucasian female was initially diagnosed with 'saddle pulmonary embolism' based on computerized tomographic angiography of the chest 2 months prior to admission and placed on anticoagulation. Dyspnea escalated, and serial computed tomography scans showed cardiomegaly with pulmonary emboli involving the right and left main pulmonary arteries with extension into the right and left upper and lower lobe branches. An echocardiogram on admission showed severe pulmonary hypertension with a pulmonary artery pressure of 82.9 mm Hg, and a severely enlarged right ventricle. Respiratory distress and multiorgan failure developed and, unfortunately, the patient expired. Autopsy showed a lobulated, yellow mass throughout the main pulmonary arteries measuring 13 cm in diameter. The mass extended into the parenchyma of the right upper lobe. On microscopy, the mass was consistent with a high-grade primary pulmonary artery leiomyosarcoma. Median survival of patients with primary pulmonary artery leiomyosarcoma without surgery is one and a half months, and mortality is usually due to right-sided heart failure. Pulmonary artery leiomyosarcoma is a rare but highly lethal disease commonly mistaken for PE. Thus, we recommend clinicians to suspect this malignancy when anticoagulation fails to relieve initial symptoms. In conclusion, early detection and suspicion of pulmonary artery leiomyosarcoma should be considered in patients refractory to anticoagulation, prompting initiation of early intervention.
546			_aEnglish
650			_aPubMed-not-MEDLINE -- Not indexed
651			_aMedstar Franklin Square Medical Center
656			_aMedicine
656			_aPulmonary and Critical Care Medicine
657			_aCase Reports
700			_aDahagam, Chanukya R
700			_aMuganlinskaya, Nargiz
700			_aSelinger, Stephen
790			_aDahagam C, Guzman A, Muganlinskaya N, Selinger SR
856			_uhttps://dx.doi.org/10.3402/jchimp.v5.29624 _zhttps://dx.doi.org/10.3402/jchimp.v5.29624
942			_cART _dArticle
999			_c4128 _d4128