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To the Editors:Pulmonary artery sarcoma is a rare tumour of the cardiovascular system. It is often misdiagnosed as acute or chronic pulmonary thromboembolism because its clinical presentation and radiological findings are similar to those of thromboembolism. The diagnosis of pulmonary artery sarcoma by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has not been reported. Herein, we report two cases with mass-like lesion in the pulmonary artery. The lesions were safely approached by EBUS-TBNA, and the tissues obtained by EBUS-TBNA were sufficient to diagnose pulmonary artery sarcoma and thromboembolism.A 79-yr-old female with hypertension and atrial fibrillation presented with sudden-onset left chest and shoulder pain. She had taken warfarin for atrial fibrillation, but the warfarin had been discontinued for 1 week because of a scheduled endoscopy. We performed chest computed tomography (CT), which revealed an extensive intraluminal low-attenuated mass- like lesion involving the entire luminal diameter of the left main and left lower lobar pulmonary artery (fig. 1a). d-dimer was 0.94 μg·mL−1 (reference value <0.4 μg·mL−1). Positron emission tomography (PET)-CT with 18F-fluorodeoxyglucose (FDG) showed increased FDG uptake, with a maximum standardised uptake value (SUV max) of 18.6 in the left main pulmonary artery (fig. 1c). For a tissue diagnosis, EBUS-TBNA was performed targeting the mass-like lesion encasing the pulmonary artery (fig. 1d). The sonograph revealed a round heterogeneous mass with distinct margin that include some necrotic area. The cytopathological examination confirmed spindle cell malignancy with vimentin …

EBUS-TBNA in the differential diagnosis of pulmonary artery sarcoma and thromboembolism