Pulmonary artery tumour-embolism diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration.

A 61-yr-old female was diagnosed with pulmonary embolism. She had a history of poorly differentiated thyroid cancer with follicular cell phenotype, and had first been treated in 2006 by thyroidectomy and radioactive iodine-131. Local relapse (cervical nodes) had occurred within 3 months and required five cycles of chemotherapy, consisting of cisplatin and doxorubicin, followed by cervical radiotherapy and surgical resection of residual nodes. 2 yrs later during follow-up, abnormal Ffluorodeoxyglucose (FDG) uptake was described on positron emission tomography (PET)/computed tomography (CT) in the left thoracic hilar regions. CT pulmonary angiography showed a filling defect in the left lower lobe pulmonary artery and at the origin of the lingular artery; no delayed embolism enhancement was observed. It was considered to be a pulmonary embolism, and anticoagulation was initiated. 6 months later, follow-up imaging showed stability of both FDG uptake and CT pulmonary angiography images, and anticoagulation was continued. 10 months later, follow-up showed a right pulmonary upper lobe nodule on CT scan associated with high FDG uptake on PET/CT, and thyroglobulin ascension. This nodule was considered to be a thyroid cancer metastasis and treated by CyberKnife radiotherapy. As FDG uptake and thyroglobulin levels remained high despite radiotherapy, a complementary treatment by radio frequency ablation was administered, leading to the disappearance of the right pulmonary upper lobe nodule. Thyroglobulin levels remained high nonetheless. A subsequent CT scan showed a persistent filling defect in the left lower lobe pulmonary artery and at the origin of the lingular artery, despite over 12 months of anticoagulation (fig. 1). No delayed thrombus enhancement was seen on this occasion either. At this time,