Presentation
Cough and nonspecific abdominal pain. Remote history of asbestos exposure. A CT chest, abdomen, and pelvis, with contrast was performed for the nonspecific abdominal symptoms.
Patient Data
Pulmonary epithelioid hemangioendothelioma
Multiple lobulated nodules found in the lungs, ranging from 4 mm to 22 mm (scan centered on largest nodule in the middle lobe). The nodules were distributed randomly. There was no cavitation or ground glass change around the nodules. No lymphadenopathy. No pleural effusion.
Case Discussion
These multiple nodules were originally detected in a CT of the chest, abdomen, and pelvis for nonspecific abdominal symptoms. A presumptive diagnosis of metastatic disease to the lung was made but no primary was found. Percutaneous needle biopsy was unsuccessful in obtaining enough tissue for pathologic analysis, so the patient underwent VATS wedge resection of the dominant nodule (pictured).
The pathology from the wedge resection was pulmonary epithelioid hemangioendothelioma (PEH), a rare vascular tumor which usually presents nonspecifically on CT as multiple randomly distributed nodules (as in this case).
Of note, although the patient had a remote history of asbestos exposure, this is not currently thought to be linked to PEH development. The etiology of PEH remains obscure and the prognosis is highly variable.
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