Abstract
BACKGROUND: Intimal sarcomas of the pulmonary artery (ISPAs) are rare tumors. Such tumors can be confused with pulmonary embolism (PE) and more common malignant diseases. CASE SUMMARY: A 73-year-old woman presented with hemoptysis and a history of recurrent PEs. A positron emission tomography scan revealed a hypermetabolic pulmonary artery mass. She underwent a transesophageal echocardiography (TEE)-guided forceps biopsy, which confirmed the diagnosis. DISCUSSION: Surgical biopsy is recommended for the diagnosis and treatment of ISPAs. In patients with intermediate surgical risk or questionable tumor origin, a presurgical biopsy can guide clinical management, and many approaches are reported. Currently, there is no recommended biopsy approach, and guidelines are unclear on biopsy indications. TAKE-HOME MESSAGES: ISPAs should be considered in a patient with a hypermetabolic pulmonary artery mass, and presurgical biopsy can guide management in older adults. An endovascular-guided forceps approach may be superior to aspiration, and TEE can improve success rates.