Sarcoidosis Mimicking Primary Pulmonary Artery Sarcoma

Area of Science:

• Cardiology
• Pulmonology
• Radiology

Background:

• A 71-year-old male patient with a history of coronary artery disease, sarcoid uveitis, and recurrent ventricular tachycardia managed with an implantable cardioverter-defibrillator presented with progressive dyspnea.
• The patient's comorbidities and existing cardiac device presented diagnostic challenges.

Observation:

• Echocardiography revealed a significant echogenic mass obstructing the proximal main pulmonary artery.
• The obstruction resulted in a severe pressure gradient of 65 mm Hg across the pulmonary artery.
• Ventilation-perfusion scintigraphy indicated widespread reduced perfusion in the left lung and a specific segmental defect in the left upper lobe.

Findings:

• The primary finding was a large pulmonary artery mass causing critical stenosis.
• Diagnostic imaging was limited due to the patient's implantable cardioverter-defibrillator, precluding cardiac MRI.
• The mass significantly impacted pulmonary blood flow, as evidenced by perfusion defects.

Implications:

• This case underscores the potential for intrapulmonary masses to cause severe pulmonary hypertension and dyspnea.
• Accurate diagnosis and management of such masses are crucial for improving patient outcomes.
• Alternative imaging modalities or strategies may be necessary in patients with contraindications like implantable cardioverter-defibrillators.