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Cardiovascular Images Pia K. Schuler, MD; Achim Weber, MD; Peter K. Bode, MD; Michael Neuhaus, MD; Rene´ Preˆtre, MD; Rolf Jenni, MD, MSEE; Ju¨rg Schwitter, MD, FESC 38-year-old woman presented with left lower chest Apain. At the age of 3 years, a commissurotomy of the pulmonary valve and infundibulectomy was performed to correct severe infundibular pulmonary stenosis. The initial thoracic CT diagnosed bilateral pulmonary embolism. Echocardiography revealed a filiforme mass in the pulmo- nary artery 33 mm in length, floating in the right outflow tract, suggesting a pulmonary sarcoma. In addition, a moderate pulmonary valve insufficiency with mild stenosis was diagnosed. Cardiac magnetic resonance (CMR) con- firmed the mass in the left pulmonary artery (PA) with floating parts and a small mass in the right PA (Figure 1) and provided complementary findings identifying the mass as tumor, differentiating it from chronic thromboembo- lism. In particular, perfusion CMR demonstrated blood flow in the mass (Figure 2A and 2B), and late contrast- enhanced CMR revealed high- and low-signal territories in the tumor suggesting heterogenous cell-rich and cell- depleted components of the mass (Figure 3). Histology as shown in Figure 4 showed the mass to be an intimal sarcoma with widespread vascularization
Circulation: Cardiovascular Imaging – Wolters Kluwer Health
Published: Sep 1, 2009
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