2023 Volume 52 Issue 5 Pages 320-324
A 46-year-old man had a 3-week history of persistent cough. Chest radiography showed a mass in the left pulmonary hilum and contrast-enhanced computed tomography (CT) showed an infiltrative mass extending from the main pulmonary trunk to the left hilar region into the lung. He was referred to our hospital for multidisciplinary treatments. Echocardiography showed that the proximal side of the tumor reached the pulmonary valve. CT revealed that the heterogeneous low-density tumor extended from the main pulmonary trunk to the left and right pulmonary arteries, and the left side of the tumor extended beyond the left pulmonary hilum into the left lung. A mass shadow of 54 mm in length was also seen in the lower lobe of the left lung along the pulmonary artery. Although the left bronchus was compressed by the tumor, there was no obvious intratracheal invasion. Direct invasion to the descending thoracic aorta was suspected. He underwent the resection of the main pulmonary trunk and the left pulmonary artery along with the tumor concomitant with total left pneumonectomy. Reconstruction of the pulmonary artery and right ventricular outflow tract were performed as follows: The right ventricular outflow tract was reconstructed by using a semilunar shaped bovine pericardial patch. The pulmonary artery was replaced by using a composite graft with a Dacron tube graft and an aortic bio-prosthesis. He was discharged on the 22nd postoperative day. The pathological diagnosis of the tumor was pulmonary artery intimal sarcoma. Although there are various reconstruction methods for pulmonary artery intimal sarcoma depending on the affected site, reconstruction of the pulmonary artery and the right ventricular outflow tract by using a composite graft are considered to be a useful method.
