PMC6838465_01
TTE, CTA and perfusion scan findings. (A) Parasternal short-axis view showing a mass within the lumen of the MPA (red arrow). (B) Apical four-chamber view demonstrating severely dilated RV. (C) Continuous-wave doppler of the tricuspid valve; the RVSP is severely elevated. (D) CTA, axial section demonstrating a columnar filling defect extending from the bifurcation to the RPA (red arrow). (E) A ventilation/perfusion scan showing extensive ventilation/perfusion mismatch. Ao: Aorta, CTA: Computed tomography angiography. LA: left atrium, LV: left ventricle, MPA: main pulmonary artery, RA: right atrium, RPA: Right pulmonary artery, RV: right ventricle, RVOT: Right ventricular outflow tract, RVSP: Right ventricular systolic pressure, TTE: Transthoracic echo.
gr1.jpg
PMC6838465_01_gr1.jpg
fig0005
The right ventricular systolic pressure was 92 mm Hg (Fig. 1A-C). The D-dimer test was positive. A contrast-enhanced computed tomography scan of the chest confirmed the echocardiographic findings and showed extension of the main pulmonary artery mass into the main branches (Fig. 1D), appearance suggestive of PE or tumor. A lung ventilation/perfusion scan revealed extensive ventilation-perfusion mismatch (Fig. 1E).
MRI (axial [A-C], coronal [D]) and TEE (E and F) images. (A) Cine image showing a saddle-shaped filling defect occupying the lumen of the MPA and bifurcation. (B) The mass is hyperintense on short-tau inversion recovery imaging (STIR) image. (C) Significant late gadolinium enhancement of the mass. (D) MRI dark blood, coronal view showing an expanding mass within the MPA-RPA, compressing LUPV (red arrow) and RUPV (blue arrow). (E) Midesophageal view with color Doppler showing flow within the mass indicating vascularity; the LUPV is compressed. (F) Transgastric view showing LA compression by the mass with a small intra-atrial mass (red arrow) most likely representing tumor invasion. Ao: aorta, LA: left atrium, LV: left ventricle, LUPV: left upper pulmonary vein, MPA: main pulmonary artery, MRI: magnetic resonance imaging, RPA: right pulmonary artery, RUPV: right upper pulmonary vein.
gr2.jpg
PMC6838465_01_gr2.jpg
fig0010
Magnetic resonance imaging was performed (Fig. 2A-D) for tissue characterization of the main pulmonary artery mass. T2-weighted short-tau inversion recovery imaging ([STIR], Fig. 2B). There was heterogeneous contrast uptake on first-pass perfusion with early enhancement, and significant late gadolinium enhancement (Fig. 2C). Compression of the left atrium and right and left upper pulmonary veins by the mass was noted (Fig. 2D). This showed compression of the left atrium and upper pulmonary veins with infiltration of the left atrial wall by the mass (Fig. 2E and F).