Hemoptysis in a patient with pulmonary angiosarcoma

Pulmonary Artery Angiosarcoma (PAS) is a rare malignant vascular tumor with an aggressive clinical course and poor prognosis. The first line therapy is the surgical resection, but an early diagnosis is difficult due to the nonspecific clinical and radiological manifestations. The purpose of this case report is to analyze the difficulties in PAS diagnosis. A 32 years-old man, with a history of hemoptysis in the last two months, undergoes total body CT, which revealed multiple nodules in his left lung, surrounded by areas of ground glass opacity, without any extra-lung lesion. Fiberoptic bronchoscopy and bronchial washing were negative for neoplastic cells and open lung biopsy was necessary for diagnosis of PAS. A surgical resection was not allowed because the left lung was hepatized, so the surgeon couldn’t reach the hilum; furthermore, the subclavian vessels were infiltrated by cancer. After a month of supportive therapy, the patient died as a consequence of multiple organ failure. Our case report underlines that PAS should be considered as a possible diagnosis for patients with hemoptysis and lung nodules surrounded by ground glass opacity.