Case 290: Intravascular Cystic Synovial Sarcoma.

Area of Science:

• Vascular Medicine
• Diagnostic Imaging
• Thrombosis Research

Background:

• Pulmonary embolism (PE) is a serious condition often requiring anticoagulation.
• Unexplained peripheral masses and edema can complicate PE management.
• Diagnostic challenges arise when symptoms suggest multiple pathologies.

Observation:

• A 26-year-old man with a history of PE presented with chest pain, a right inguinal mass, and right lower extremity edema.
• Physical examination revealed a palpable 4x3 cm right inguinal mass.
• Laboratory work-up showed normal d-dimer but prolonged prothrombin time and activated partial thromboplastin time.

Findings:

• Pulmonary CT angiography initially diagnosed a left lower lobe segmental pulmonary embolus.
• Vascular ultrasound and CT imaging of the lower abdomen were performed for further evaluation of the inguinal mass and edema.
• The findings indicated a deep vein thrombosis (DVT) in the right lower extremity, presenting as an inguinal mass.

Implications:

• This case underscores the need for comprehensive diagnostic workup in patients with pulmonary embolism presenting with atypical symptoms.
• It highlights the potential for deep vein thrombosis to manifest with unusual signs such as a palpable inguinal mass.
• Early and accurate diagnosis of DVT is crucial for appropriate management and prevention of complications.