DOI: 10.12890/2026_006384

Pulmonary embolism or pulmonary artery intimal sarcoma? Diagnostic pitfalls in a rare vascular malignancy

Authors

  • Raffaele Natale Internal Medicine, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy 0009-0009-9672-0494
  • Sara Mangiacapra Department of Internal Medicine, AORN San Giuseppe Moscati Avellino Campania, Italy
  • Natalina Iuliano Department of Internal Medicine, AORN San Giuseppe Moscati Avellino Campania, Italy
  • Mariagrazia Nunziata Department of Internal Medicine, AORN San Giuseppe Moscati Avellino Campania, Italy
  • Valeria Iorio Department of Internal Medicine, AORN San Giuseppe Moscati Avellino Campania, Italy
  • Maria Amitrano Department of Internal Medicine, AORN San Giuseppe Moscati Avellino Campania, Italy
  • Lidia Santarpia Internal Medicine, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy

raffaelenatale1993@gmail.com

Keywords

Pulmonary artery intimal sarcoma, pulmonary embolism, differential diagnosis

Abstract

Pulmonary artery obstruction is commonly attributed to pulmonary embolism; however, rare malignant conditions may present with similar clinical and radiological findings. Failure to recognize these alternative diagnoses may result in inappropriate treatment and delayed management.
We report the case of a 48-year-old man presenting with acute dyspnoea and cough. Computed tomography angiography revealed a filling defect in the right main pulmonary artery, and pulmonary embolism was diagnosed. Despite appropriate anticoagulant therapy, the patient’s clinical condition progressively deteriorated. The absence of deep vein thrombosis and the lack of right heart strain prompted diagnostic reconsideration. Endobronchial ultrasound-guided fine-needle aspiration revealed malignant spindle cell proliferation, and immunohistochemistry confirmed pulmonary artery intimal sarcoma.
This case highlights the importance of reconsidering the diagnosis when clinical improvement does not occur despite adequate anticoagulation. Pulmonary artery obstruction should not automatically be attributed to thromboembolism, and malignancy must be considered in the differential diagnosis.

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References

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Published

2026-04-07

Issue

Vol. 13 No. 4 (2026)

Categories

How to Cite

1.
Natale R, Mangiacapra S, Iuliano N, Nunziata M, Iorio V, Amitrano M, et al. Pulmonary embolism or pulmonary artery intimal sarcoma? Diagnostic pitfalls in a rare vascular malignancy. EJCRIM [Internet]. 2026 Apr. 7 [cited 2026 Nov. 3];13(4). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6384

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