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Chest clinic
Case based discussion
Metastatic synovial sarcoma of lung mimicking pulmonary embolism and deep venous thrombosis
  1. Jiaojiao Qiu1,2,
  2. Wanmu Xie1,3,4,
  3. Zhenguo Zhai1,3,4,
  4. Jun Wan1,3,4,
  5. Chen Wang1,3,4,5
  1. 1Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
  2. 2Department of Cardiovascular Medicine, China-Japan Friendship Hospital, Beijing, China
  3. 3Department of Respiratory Medicine, Capital Medical University, Beijing, China
  4. 4Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
  5. 5National Clinical Research Center for Respiratory Diseases, Beijing, China
  1. Correspondence to Dr Wanmu Xie, Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, 2 Yinghua Dongjie, ChaoYang District, Beijing 100029, China; xiewanmu{at}126.com

https://doi.org/10.1136/thoraxjnl-2016-209029

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    Introduction

    Synovial sarcoma (SS) is a highly aggressive mesenchymal malignancy that usually originates from deep soft tissues of the extremities. Lungs are the most common metastatic site, but rare cases of vascular metastasis have been reported. Here we report a case of metastatic SS in a 26-year-old male patient with right lower extremity oedema first misdiagnosed as deep venous thrombosis (DVT). CT pulmonary angiogram (CTPA) revealed a mass lesion inside the right pulmonary artery mimicking PE. The diagnosis of SS was established by histopathological examination acquired by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) from the right pulmonary artery. 18FDG-PET revealed that breviductor and pectineus muscle was the original site of SS with metastasis in common and external iliac veins, pulmonary artery and pulmonary parenchyma.

    Case report

    A 26-year-old man presented to our hospital with repeated right leg swelling and chest pain. Nine months before hospitalisation, the patient had right leg swelling and was diagnosed with DVT according to an ultrasound scan. Catheter-directed thrombolysis was performed followed by anticoagulation. The patient had slight relief in symptoms. Seven months later he had intermittent chest pain. …

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    Footnotes

    • Contributors JQ was a resident and wrote the first draft. WX, ZZ, JW and CW worked together and developed the therapy regimes and revised the manuscript. All authors had access to the data and played a role in writing this manuscript. WX is corresponding author.

    • Funding This work was supported by the National Key Technology R&D Program of the Ministry of Science and Technology (2016YFC0905600, 2016YFC0905601, 2012BAI05B02), the National Natural Science Foundation of China (81570049) and the Beijing Natural Science Foundation (7152062).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.