A case of primary pulmonary artery leiomyosarcoma with emergency surgery for bilateral pulmonary artery occlusion

A 58-year-old man visited the hospital with fever, cough, and bloody sputum. Thoracic computed tomography showed a space-occupying lesion within the pulmonary artery, with complete occlusion of the left pulmonary artery and severe stenosis of the right pulmonary artery. The patient was initiated on anticoagulant therapy; however, 4 days later, he developed respiratory failure and went into shock. Hence, bilateral pulmonary artery occlusion was diagnosed, and emergency surgery was conducted on the patient. Surgery revealed bilateral pulmonary artery occlusion due to tumors, and the tumor was partially removed. Further, the occlusion was relieved, and the pathological findings indicated leiomyosarcoma. Thereafter, the patient was readmitted for abdominal pain. Imaging tests showed a re-enlarged mass in the pulmonary artery and a large intra-abdominal mass. Chemotherapy was considered, but the patient experienced cardiopulmonary arrest on the third day of hospital readmission and died. Pathological autopsy showed that the cause of death was bilateral pulmonary artery occlusion caused by a tumor. Primary pulmonary artery sarcoma is rare disease and is often the initial diagnosis is pulmonary thromboembolism; hence, differential diagnosis is important. The prognosis is poor; however, long-term prognosis can be expected with surgical resection. Hence, early diagnosis and treatment are important.