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Unilateral Usual Interstitial Pneumonia Associated with Sarcoma of the Pulmonary Artery

Semin Chong1, Tae Sung Kim1, Man Pyo Chung2, Eun Yoon Cho3 and Jhingook Kim4

1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
3 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
4 Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.


Figure 1
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  		Fig. 1A —52-year-old man with unilateral usual interstitial pneumonia associated with pulmonary artery sarcoma. Initial contrast-enhanced chest CT scan obtained with mediastinal window at local hospital shows intraluminal filling defect (arrows) in right main pulmonary artery.

 

Figure 2
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  		Fig. 1B —52-year-old man with unilateral usual interstitial pneumonia associated with pulmonary artery sarcoma. Initial contrast-enhanced chest CT scan obtained with lung window at level of inferior pulmonary vein shows no abnormal findings in underlying lungs.

 

Figure 3
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  		Fig. 1C —52-year-old man with unilateral usual interstitial pneumonia associated with pulmonary artery sarcoma. Contrast-enhanced chest CT scan obtained with mediastinal window at our institution 5 years after A and B shows intravascular mass (straight arrows) in right main pulmonary artery has grown and extends to lobar pulmonary arteries. New appearance of hypertrophied right bronchial artery (curved arrow) and intercostal arteries (arrowheads) suggests presence of collateral vessels for systemic arterial supply to chronically ischemic lung.

 

Figure 4
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  		Fig. 1D —52-year-old man with unilateral usual interstitial pneumonia associated with pulmonary artery sarcoma. High-resolution (1-mm collimation) CT scan obtained with lung window at level of inferior pulmonary vein shows subpleural areas of ground-glass attenuation and irregular linear opacities with honeycombing (arrowheads) in right middle and lower lobes. Findings suggest usual interstitial pneumonia involving only ipsilateral right lung.

 

Figure 5
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  		Fig. 1E —52-year-old man with unilateral usual interstitial pneumonia associated with pulmonary artery sarcoma. Photograph of pneumonectomy specimen shows pale yellowish myxoid intravascular mass in right main pulmonary artery and extending to lobar pulmonary arteries (arrows). Area of subpleural fibrosis and honeycombing is evident in right lower lobe (star).

 

Figure 6
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  		Fig. 1F —52-year-old man with unilateral usual interstitial pneumonia associated with pulmonary artery sarcoma. Photomicrograph of biopsy specimen obtained from subpleural area of right lower lobe shows areas of microscopic honeycombing (arrows) and irregular interstitial fibrosis (star). Findings are consistent with usual interstitial pneumonia. (H and E, x40)

 

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