Pulmonary artery (PA) leiomyosarcoma (PAL) is a rare but extremely malignant tumor of the cardiovascular system, which is often misdiagnosed as pulmonary thromboembolism. Although the early detection and surgical resection improves patient survival, the benefits of adjuvant therapy are not well understood. The current study presents the case of a patient with primary PAL who underwent surgical resection along with three courses of chemotherapy. Despite these interventions, the patient experienced recurrence of the PAL within four months following treatment. The patient received localized radiotherapy and subsequently achieved a stable disease state. This case indicates that radiotherapy may offer a benefit to PAL patients, particularly those who do not respond to chemotherapy.

/pdf/treatment-of-a-recurrent-pulmonary-artery-leiomyosarcoma-3sfoftc8rg.pdf

Treatment of a recurrent pulmonary artery leiomyosarcoma with a combination of surgery, chemotherapy, and radiotherapy: A case report and literature review.

The novel coronavirus disease 2019 (COVID-19) has spread rapidly around the world after the first cases were reported in December 2019 in China. Despite the prevention of the symptoms presented, extrapulmonary manifestations were identified. In particular, there was an increase in cases of Acute Mesenteric Ischemia (AMI), raising its incidence to 1.9%-3.8% in infected patients. The aim of this study was to investigate the existence of an association between IMA and COVID-19 through the literature. An Integrative Literature Review was carried out. The research question was "mesenteric ischemia in patients with COVID-19: coincidence or association?". After searching the database and applying the inclusion and exclusion criteria, 44 were selected for analysis. COVID-19 was confirmed by RT-PCR and imaging tests, gastrointestinal manifestations, alterations and primarily tomographic imaging findings were identified. Most patients were accelerated to laparotomy. As explanations include direct endothelial and injury by the binding of the ACE-2 virus, between hyperinflammation and hypercoagulability, dysregulation of the renin-angiotensin-aldosterone system and factors associated with the severity of the virus. IMA is an emergency with high associated morbidity and mortality, these cases may be a consequence mainly of the thromboinflammatory mechanism associated with SARS-CoV-2. An early diagnosis, diagnosis and diagnoses are crucial to clinical treatment; an assessment regime should be considered in accordance with current evidence and guidelines.

Acute mesenteric ischemia and COVID-19: an integrative review of the literature.

Involvement of the gastrointestinal (GI) system in corona virus disease-19 (COVID-19) in form of diarrhea, loss of taste, nausea, and anorexia is common and associated with poor prognosis. COVID-19 is also associated with a hypercoagulable state that mainly involves the pulmonary vasculature. However, GI complications involving thrombosis are observed infrequently. We report two COVID-19 patients who had two different causes of acute abdomen. The first patient was a 49-year-old male diagnosed with an aortic thrombus along with a splenic infarct. He was diagnosed early and successfully managed with anticoagulants. The second patient was a 30-year-old male who developed pain in the abdomen and was found to have features suggestive of peritonitis. A contrast-enhanced computerized tomography (CECT) scan of the abdomen revealed dilated bowel loops. Immediate exploratory laparotomy was performed; he was found to have jejunal perforation with gangrene. Histopathological examination of the resected specimen showed inflammatory cells with edema and thrombotic vessels. However, he succumbed to sepsis and multiorgan failure. Therefore, it is important to investigate cases of acute abdomen in COVID-19 thoroughly and whenever indicated CT angiogram should be obtained. 

/pdf/thrombosis-leading-to-acute-abdomen-in-corona-virus-disease-3bfwrkm7.pdf

Thrombosis leading to acute abdomen in corona virus disease- 19:A case series

Pulmonary artery leiomyosarcoma is an extremely rare disease, with only a few dozen cases reported worldwide to date. This disease is easily misdiagnosed as pulmonary thromboembolism, leading to improper treatment and accurate diagnosis in the later stages of the disease. Furthermore, this delayed diagnosis may also be the reason for the extremely high mortality rate of patients suffering from it. Early invasive surgery with the goal of complete surgical resection is the standard treatment method. Chemotherapy and radiation therapy have been tried with variable outcomes.

Primary Pulmonary Artery Leiomyosarcoma with Pulmonary Metastasis Depicted on Enhanced Computer Tomography: A Case Description and an Analysis of the Literature


 Introduction: COVID-19 is associated with increased coagulability, resulting in thromboembolic complications, such as intestinal ischemia. Diagnosis of bowel infarction can be challenging due to the severity of illness and the laboratory changes associated with the COVID-19 infection itself.

 Case Series: In a retrospective monocentric study, we performed an in-depth analysis of the clinical course of intestinal ischemia in COVID-19 patients. Biochemical analysis of coagulation status and predictors of ischemia was performed. We identified five patients with intestinal ischemia, between March 2020 and January 2021. Mean time-to-onset of intestinal ischemia from COVID-diagnosis was 31 days (range 16–56). Intestinal ischemia was confirmed by contrast-enhanced computed tomography (CT) scan. D-dimer, Fibrinogen, C-reactive protein (CRP), and lactate dehydrogenase (LDH) were elevated prior to the ischemic event, but no recurrent pattern could be distinguished in our case series. Lactate levels demonstrated a marked increase at the time of ischemia in our series. No consistent findings were made for prothrombin time (PT) and activated partial thromboplastin time (aPTT) and creatin kinase. Extent of bowel ischemia varied between limited to the ileocecal region (two patients), additional ischemia of small and large bowel (two patients) and extensive ischemia of entire intestinal tract (one patient). Four patients (80%) required an ileostomy. Planned relook surgery was performed in three patients (60%). Three (60%) patients died.

 Conclusion: In the five days prior to an intestinal ischemic event in COVID-19 patients, we did not identify a clear pattern in commonly used markers for coagulation status and ischemia. However, lactate levels showed a recurrent pattern of clear increase leading up to the ischemic event and rapid normalization after surgery. Unfortunately, our patient numbers were too small to draw definitive conclusions.


https://www.casereportsinternational.com/archive/2023/pdf/100113Z06TW2023.pdf

Intestinal ischemia in COVID-19 patients: A case series

Background. Primary pulmonary artery sarcomas are very rare and their histologic type, called leiomyosarcoma, is even rarer. Case Report. A 64-year-old woman presented with progressive weakness, fatigue, malaise, and dyspnea, and a marked elevation of pulmonary artery pressure was admitted. She was initially diagnosed with chronic pulmonary thromboembolism and chest computed tomography (CT) scan revealed that lobulated heterogeneous left hilar mass extended to precarinal and subcarinal space. MRI demonstrated a polypoid lesion at trunk with extension to left main pulmonary artery and its first branch. She was operated, a yellowish-shiny solid mass in pulmonary trunk was seen intraoperatively, and pulmonary endarterectomy was performed. Her tumor was pathologically diagnosed as pulmonary artery leiomyosarcoma. She died 3 months later after one chemotherapy course. Conclusion. Initially, the patient underwent surgery due to pulmonary embolism but, during the operation, the observed mass increased the probability of pulmonary artery neoplasm. Clinicians must consider pulmonary artery sarcoma when making the differential diagnosis for patients with pulmonary arteries masses. In addition to clinical prediction scores and CT and MRI findings to identify the patients with pulmonary artery sarcoma, PET scanning is the diagnosis of choice in differentiating embolism and neoplasm and is strongly recommended in these patients.

/pdf/pulmonary-hypertension-due-to-a-pulmonary-artery-11073u4wqs.pdf

Pulmonary Hypertension due to a Pulmonary Artery Leiomyosarcoma: A Case Report

Coronavirus disease 2019 (COVID-19) is an acute respiratory illness caused by novel coronavirus SARS-CoV-2. The clinical manifestations of this infection have a range and typically include impairment of smell, taste disturbance, cough, fever, and shortness of breath. Gastrointestinal manifestations have been reported in anywhere from 3% to 50% of patients with concomitant SARS-CoV-2 pulmonary infection. Abnormalities in coagulation markers have been reported in patients hospitalized with COVID-19. During this article, we will introduce a patient with COVID 19 but with the most manifestation of abdominal pain due to intestinal ischemia and mesenteric vascular thrombosis.

/pdf/intestinal-ischemia-due-to-mesenteric-vascular-thrombosis-in-2sly1zcqv4.pdf

Intestinal Ischemia Due to Mesenteric Vascular Thrombosis in a Patient with Positive SARS-Cov-2 RNA without Primary Pulmonary Symptom: A Case Report.

BACKGROUND: Primary pulmonary artery sarcomas are very rare and their histologic type called leiomyosarcoma is even rarer. These tumors are frequently misdiagnosed as pulmonary thromboembolism in clinical settings. Many patients receive anticoagulant therapy without response, and many are diagnosed postmortem only. Most of the tumors reported in the literature have involved the right ventricular outflow tract and the main pulmonary trunk, often extending into the main pulmonary artery (MPA) branches. CASE REPORT: A 64-year-old woman presented with weakness, fatigue, malaise, dyspnea, and marked elevation of pulmonary artery pressure was admitted to our hospital. She was initially diagnosed with chronic pulmonary thromboembolism, and chest computed tomography (CT) scan revealed lobulated heterogeneous left hilar mass extended to precarinal and subcarinal space. Magnetic resonance imaging (MRI) demonstrated a polypoid lesion at the trunk with extension to left MPA and its first branch. The patient was operated, and a yellowish-shiny solid mass in pulmonary trunk was seen intra-operation and pulmonary endarterectomy was performed. Her tumor was pathologically diagnosed as pulmonary artery leiomyosarcoma. CONCLUSION: Clinicians must consider pulmonary artery sarcoma when making the differential diagnosis for patients with pulmonary artery masses. The clinical prediction scores and the CT and MRI findings can help identifying patients with pulmonary artery sarcoma. Keywords: Hypertension, Leiomyosarcoma, Pulmonary Artery, Pulmonary Embolism

http://www.arya.mui.ac.ir/index.php/arya/article/download/549/1277

Pulmonary hypertension due to a pulmonary artery leiomyosarcoma: A case report.

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Pulmonary Hypertension due to a Pulmonary Artery Leiomyosarcoma: A Case Report

Intestinal Ischemia Due to Mesenteric Vascular Thrombosis in a Patient with Positive SARS-Cov-2 RNA without Primary Pulmonary Symptom: A Case Report.

Pulmonary hypertension due to a pulmonary artery leiomyosarcoma: A case report.