Asian Cardiovasc Thorac Ann 2005;13:400
© 2005 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
An Unusual Cause of Syncope
Jacques Kpodonu, MD,
Robert J Cusimano, MD,
Michael R Johnston, MD1
The Division of Cardiovascular Surgery
1 Division of Thoracic Surgery, Toronto General Hospital, The University of Toronto, Ontario, Canada
For reprint information contact: Jacques Kpodonu, MD Tel:1 416 944 2206 Fax: 1 416 340 4385 Email:jkpodonu{at}rogers.com, Division of Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G2C4, Canada.
A 53-year-old man presented with several episodes of syncope. A CT scan of his chest demonstrated a pulmonary artery mass (Figure 1A and 1B
) occupying most of his main pulmonary artery as well as the left and right pulmonary artery. Biopsy performed was suggestive of a pulmonary artery sarcoma. He underwent successful resection and made an uneventful recovery.
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Figure 1. Axial (A) and sagittal (B) reformatted CT images demonstrating extension of sarcoma from the level of the pulmonary valve to the region of pulmonary artery bifurcation.
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Leiomyosarcomas of the pulmonary artery are extremely rare tumors often misdiagnosed as chronic pulmonary embolism leading to inappropriate therapy such as prolonged anticoagulation or thrombolysis. Enhancement of an intraluminal-filling defect with gadolinium-diethylenetriamine pentaacetic acid on MRI has been suggested as a sensitive way of differentiating a tumor mass from a thrombus. Pulmonary leiomyosarcomas have a poor prognosis without a response to chemotherapy. Aggressive surgical resection has been shown to improve survival and should be attempted provided there is a clinical and radiological response of the tumor to chemotherapy.
