Author + information
- Received January 17, 2019
- Revision received January 26, 2019
- Accepted February 12, 2019
- Published online April 15, 2019.
- Shinya Nagayoshi, MDa,∗ (, )
- Christian Michael H. Pawhay, MDb,
- Shinya Fujii, MDa,
- Takatomo Nakajima, MD, PhDa,
- Yoshihiko Shimizu, MD, PhDc and
- Makoto Muto, MD, PhDa
- aDivision of Cardiology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
- bDivision of Internal Medicine Adult Clinical and Nuclear Cardiology, National Kidney and Transplant Institute, Quezon City, Philippines
- cDivision of Pathology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
- ↵∗Address for correspondence:
Dr. Shinya Nagayoshi, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya City, Saitama 360-0197, Japan.
A 79-year-old man with rectal carcinoma presented with a productive cough. Contrast-enhanced computed tomography (CT) scan revealed an intraluminal mass in the right (A10) pulmonary artery (Figures 1A to 1D). Considerations included leiomyosarcoma, intravascular lymphomatosis, and metastatic carcinoma. A pulmonary wedge catheter was used to aspirate contents from the pulmonary artery, but cytology revealed no tumor cells. Transbronchial CT-guided needle biopsy of the intraluminal tumor was not considered due to the high risk of bleeding.
A first-in-man transcatheter approach combined with balloon pulmonary angioplasty (BPA) was therefore performed. An 8-F 65-cm sheath was inserted in the right internal jugular vein, followed by an 8-F JR40SH guiding catheter. Inserting the biopsy forceps into the A10a segment proved difficult because of the acute angle of the artery beyond its origin, and the tumor occluding the A10b segment just after branching (Figure 1E, Online Video 1).To circumvent this, BPA was performed. First, a 0.014-inch guidewire was used to cross the occluded vessel. Intravenous ultrasound confirmed the guidewire placement and was used to measure the proximal and distal luminal diameters (5 mm and 3 mm, respectively). A 3 × 20-mm balloon catheter was then used to perform BPA (Figures 1F and 1G, Online Video 2). Thereafter, the guiding catheter was successfully advanced to engage the occluded vessel, and transcatheter tumor biopsy was performed (Figure 1H, Online Video 3). Positive tumor staining with chromogranin A, synaptophysin, and CD56 (Figure 1I) was indicative of a neuroendocrine tumor. This, together with the histological pattern (Figure 1J), diagnosed small cell lung carcinoma.
BPA made it possible to open up a distal pulmonary artery occlusion and access the difficult-to-reach tumor in this case.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 17, 2019.
- Revision received January 26, 2019.
- Accepted February 12, 2019.
- 2019 American College of Cardiology Foundation