Supplementary Material for: High-grade sarcoma of the pulmonary artery that mimicked a pulmonary embolism in a 39-year-old patient with recurrent miscarriages: a case report

Introduction
Primary pulmonary artery sarcoma (PPAS) is a rare malignancy with a poor prognosis, undefined treatment guidelines, and is often mistaken for a pulmonary embolism based on similar clinical presentation and radiographic findings.

Case Presentation
We present a case of a 39-year-old female with a past medical history of recurrent miscarriages who presented with a chief complaint of dyspnea. Due to a history of recurrent miscarriages, a predisposing coagulopathic condition was suspected for a pulmonary embolism. A V/Q scan showed high probability for a pulmonary embolism with bilateral perfusion defects. Subsequent CT angiographic imaging of the chest was read as positive for a massive pulmonary embolism. The patient was transferred to the medical ICU for tPA administration, but developed worsening hypoxic respiratory failure and was transferred to an outside hospital for expert surgical consultation and thrombectomy. Intraoperative reports during thrombectomy commented on a mass within the pulmonary artery. Subsequent pathology showed a high-grade sarcoma. The patient was started on adjuvant chemotherapy with doxorubicin, ifosfomide, and MESNA, however, due to multiple comorbidities, the patient ultimately succumbed to her illness.

Conclusion
This case underscores the diagnostic difficulty in distinguishing pulmonary artery sarcomas from a pulmonary embolism, especially in the presence of other confounders and biases.