Abstract
Pulmonary artery intimal sarcoma is a very rare and often misdiagnosed cause of pulmonary artery occlusion and progressive dyspnoea. A case of a 66-year-old man is presented, initially treated for presumed pulmonary embolism, in whom persistent intraluminal filling defects and inadequate therapeutic response ultimately led to the diagnosis of intimal sarcoma. Teaching point: Pulmonary artery intimal sarcoma should be considered in cases of persistent suspected pulmonary embolism unresponsive to adequate anticoagulation or thrombolysis, with imaging features such as SUVmax, metabolic tumour volume, total lesion glycolysis, and the wall eclipsing sign helping in the differentiation between the two entities.