Letter to the Editor
The Role of Imaging in Suspected Pulmonary Artery Tumors
Rol de las pruebas de imagen en las sospechas de tumor de arteria pulmonar
Edson Marchiori
, Gláucia Zanetti, Bruno Hochhegger
Corresponding author
Servicio de Radiología, Federal University of Río de Janeiro, Río de Janeiro, Brazil
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An extensive irregular filling defect with inhomogeneous attenuation occupies the right main pulmonary artery and extends into the pulmonary artery branches, with increased vascular diameters (arrowheads). Note also the beaded aspect of a peripheral artery (arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the letter to the editor by Laguna Sanjuanelo et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> who reported the case of a 68-year-old woman presenting a space-occupying lesion in the left pulmonary artery (PA), suggestive of intramural thrombus. She was treated with anticoagulants for 1 year. The diagnosis of a tumor was suggested because follow-up radiologic studies showed progression of the intra-arterial lesion. The final diagnosis was small-cell lung cancer metastasis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The authors commented on the difficulty of determining the nature of this type of lesion. We would like to highlight the role of imaging techniques as important tools in the differential diagnosis between malignant PA tumors and pulmonary thromboembolism. Patients with PA tumors often present with dyspnea, cough, hemoptysis, and/or chest pain. Because these symptoms can mimic pulmonary emboli, some patients are treated initially with anticoagulation therapy.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The diagnosis of PA tumor should be considered clinically in the absence of risk factors for pulmonary embolism, such as deep venous thrombosis, and when patients show a lack of response to anticoagulant therapy. Other characteristics, such as rapidly developing symptoms, weight loss, fever, anemia, and high erythrocyte sedimentation rate, may be subtle clues for diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Computed tomography (CT) and magnetic resonance imaging (MRI) are considered to be the most useful tools for differentiation between a tumor and a thrombus.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> Both diseases appear as low-attenuation intraluminal filling defects on contrast-enhanced CT, and radiologic differentiation between PA tumor and PA thromboembolism can be difficult.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> CT findings indicative of PA tumor (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) include hypodense filling defect with inhomogeneous attenuation occupying the entire lumen of the artery, with an increase in diameter of the involved vessel; contiguous soft tissue-filled PAs with occupation of the entire lumen; vascular distention from tumor growth; beaded peripheral PA; extravascular extension of the thrombus; and patchy and delayed contrast uptake on CT angiography.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">MRI with gadolinium contrast could also help to distinguish a tumor from a thrombus.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Criteria suggesting PA tumor are similar to those for CT: soft-tissue density in PAs with inhomogeneous high or low attenuation (hemorrhage, necrosis); vascular distension; and heterogeneous uptake after administration of gadolinium, indicating neovascularization.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Early diagnosis and radical surgical resection present the only opportunity for a potential cure.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> A precise preoperative diagnosis enables selection of the best surgical approach and technique, and allows time for ordering prostheses or homografts, which are not always readily available.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In the presence of suspicious imaging findings, CT-guided needle biopsy may provide the correct diagnosis preoperatively.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Marchiori E, Zanetti G, Hochhegger B. Rol de las pruebas de imagen en las sospechas de tumor de arteria pulmonar. Arch Bronconeumol. 2016;52:222.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 695 "Ancho" => 995 "Tamanyo" => 84983 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial contrast-enhanced chest computed tomography of a 35-year-old woman with dyspnea, chest pain, and hemoptysis over several months. An extensive irregular filling defect with inhomogeneous attenuation occupies the right main pulmonary artery and extends into the pulmonary artery branches, with increased vascular diameters (arrowheads). Note also the beaded aspect of a peripheral artery (arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraluminal lesion of the pulmonary artery: a diagnostic challenge" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Laguna Sanjuanelo" 1 => "J. Zabaleta" 2 => "B. 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Hauser" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "1995" "volumen" => "50" "paginaInicial" => "1014" "paginaFinal" => "1015" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8539663" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000004/v2_201604010234/S1579212915002074/v2_201604010234/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000004/v2_201604010234/S1579212915002074/v2_201604010234/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915002074?idApp=UINPBA00003Z" ]
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| 2020 November | 48 | 24 | 72 |
| 2020 October | 24 | 16 | 40 |
| 2020 September | 50 | 10 | 60 |
| 2020 August | 22 | 15 | 37 |
| 2020 July | 35 | 17 | 52 |
| 2020 June | 40 | 7 | 47 |
| 2020 May | 39 | 18 | 57 |
| 2020 April | 60 | 16 | 76 |
| 2020 March | 34 | 10 | 44 |
| 2020 February | 42 | 25 | 67 |
| 2020 January | 50 | 14 | 64 |
| 2019 December | 44 | 20 | 64 |
| 2019 November | 37 | 21 | 58 |
| 2019 October | 29 | 11 | 40 |
| 2019 September | 29 | 14 | 43 |
| 2019 August | 29 | 14 | 43 |
| 2019 July | 23 | 18 | 41 |
| 2019 June | 20 | 5 | 25 |
| 2019 May | 20 | 10 | 30 |
| 2019 April | 51 | 10 | 61 |
| 2019 March | 20 | 10 | 30 |
| 2019 February | 20 | 15 | 35 |
| 2019 January | 23 | 12 | 35 |
| 2018 December | 35 | 20 | 55 |
| 2018 November | 47 | 22 | 69 |
| 2018 October | 57 | 21 | 78 |
| 2018 September | 25 | 6 | 31 |
| 2018 May | 17 | 0 | 17 |
| 2018 April | 23 | 2 | 25 |
| 2018 March | 32 | 2 | 34 |
| 2018 February | 47 | 5 | 52 |
| 2018 January | 39 | 5 | 44 |
| 2017 December | 20 | 3 | 23 |
| 2017 November | 12 | 5 | 17 |
| 2017 October | 10 | 8 | 18 |
| 2017 September | 18 | 4 | 22 |
| 2017 August | 17 | 16 | 33 |
| 2017 July | 11 | 1 | 12 |
| 2017 June | 26 | 11 | 37 |
| 2017 May | 26 | 8 | 34 |
| 2017 April | 26 | 8 | 34 |
| 2017 March | 10 | 2 | 12 |
| 2017 February | 13 | 4 | 17 |
| 2017 January | 13 | 8 | 21 |
| 2016 December | 15 | 15 | 30 |
| 2016 November | 27 | 22 | 49 |
| 2016 October | 32 | 23 | 55 |
| 2016 September | 15 | 8 | 23 |
| 2016 August | 39 | 7 | 46 |
| 2016 July | 35 | 12 | 47 |
Show all
