{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:39:01Z","timestamp":1787236741794,"version":"build-2736575974"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T00:00:00Z","timestamp":1781395200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":67,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hemoptysis is a common clinical symptom, which can be caused by a wide spectrum of local, systemic, benign and malignant pathologies. Hemoptysis in conjunction with multiple pulmonary nodules raises suspicion for granulomatous diseases (such as granulomatosis with polyangiitis) or pulmonary metastases from a distant malignancy. Here, we report an unusual case of a patient who presented with subjective fever, hemoptysis and scattered pulmonary nodules, and was subsequently diagnosed with pulmonary angiosarcoma (probable primary pulmonary origin).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 67-year-old North American White gentleman of Greek ancestry initially presented with fever, cough, and dyspnea, and was found to have reticulonodular pulmonary infiltrates. Over the next 5\u00a0months, he developed persistent constitutional symptoms and new hemoptysis. During this interval, he underwent serial outpatient evaluations and was treated empirically for presumed pneumonia and heart failure, followed by unrevealing infectious, interstitial lung disease, and rheumatologic workup. At 6\u00a0months, CT demonstrated multiple bilateral pulmonary nodules and masses, and bronchoscopy with transbronchial needle biopsy showed only hemosiderin-laden macrophages, consistent with chronic alveolar hemorrhage. One month later, during a third hospitalization for worsening hemoptysis and hypoxemia, repeat imaging showed progression of innumerable pulmonary nodules and new liver lesions. Ultrasound-guided percutaneous liver biopsy was nondiagnostic, revealing fibrosis, bile ductular proliferation, and granulomatous inflammation without malignancy. During the same hospitalization, thoracoscopic wedge biopsy of the lung was performed. Final surgical pathology, available 1 week later, demonstrated CD34 and factor-VIII-positive malignant cells, establishing the diagnosis of pulmonary angiosarcoma (probable primary pulmonary origin). Thus, definitive diagnosis was made\u2009&gt;\u20097\u00a0months after initial presentation. By this time, the patient was profoundly deconditioned and no longer a candidate for systemic chemotherapy; he died approximately 1\u00a0month after diagnosis and 8\u00a0months after presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Recurrent hemoptysis along with widespread pulmonary nodules is a non-specific presentation, which can be caused by pulmonary angiosarcoma in rare cases. A surgical wedge biopsy is necessary for accurate diagnosis as percutaneous biopsies provide insufficient tissue to delineate the histopathological characteristics pathognomonic of this malignancy. A high index of suspicion and early surgical consultation is necessary to establish an accurate diagnosis and initiate timely treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13256-026-06211-8","type":"journal-article","created":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T03:54:32Z","timestamp":1781409272000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Delayed diagnosis of pulmonary angiosarcoma in a patient presenting with recurrent hemoptysis and widespread pulmonary nodules: a case report"],"prefix":"10.1186","volume":"20","author":[{"given":"Hafiz","family":"Javed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arfa","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8398-7810","authenticated-orcid":false,"given":"Abdul","family":"Rehman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0250-3504","authenticated-orcid":false,"given":"Hafiza Noor Ul Ain","family":"Baloch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zohreh","family":"Zaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,14]]},"reference":[{"issue":"11","key":"6211_CR1","doi-asserted-by":"publisher","first-page":"7267","DOI":"10.4103\/jfmpc.jfmpc_870_22","volume":"11","author":"SK Munjal","year":"2022","unstructured":"Munjal SK, Natarajan S, Vinay V, Meenakshisundaram A. Clinical profile of patients hospitalized with hemoptysis. J Fam Med Prim Care. 2022;11(11):7267\u201371.","journal-title":"J Fam Med Prim Care"},{"issue":"1","key":"6211_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.21037\/amj-23-99","volume":"9","author":"JK Chandler","year":"2024","unstructured":"Chandler JK, Reid MM, Pitts L, Postigo Jasahui MR. Evaluation & management of clinically significant hemoptysis\u2014a clinical practice review. AME Med J. 2024;9(1):1.","journal-title":"AME Med J"},{"issue":"2","key":"6211_CR3","doi-asserted-by":"publisher","DOI":"10.1016\/j.chpulm.2025.100168","volume":"3","author":"A Chowdhary","year":"2025","unstructured":"Chowdhary A, Rochlani H, Fein DG, Ustun B, Sadoughi A, Vimolratana M, et al. A 53-year-old female with dyspnea and hemoptysis. CHEST Pulmonary. 2025;3(2): 100168.","journal-title":"CHEST Pulmonary"},{"issue":"5","key":"6211_CR4","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1111\/1759-7714.12376","volume":"7","author":"Y Ren","year":"2016","unstructured":"Ren Y, Zhu M, Liu Y, Diao X, Zhang Y. Primary pulmonary angiosarcoma: three case reports and literature review. Thorac Cancer. 2016;7(5):607\u201313.","journal-title":"Thorac Cancer"},{"issue":"17","key":"6211_CR5","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000042106","volume":"104","author":"M Onyszczuk","year":"2025","unstructured":"Onyszczuk M. Primary pulmonary angiosarcoma mimicking acute interstitial pneumonia\u2014a diagnostic challenge: a case report. Medicine (Baltimore). 2025;104(17): e42106.","journal-title":"Medicine (Baltimore)"},{"issue":"2","key":"6211_CR6","doi-asserted-by":"publisher","first-page":"415","DOI":"10.4103\/ijpm.ijpm_794_23","volume":"68","author":"S Wei","year":"2025","unstructured":"Wei S, Han Y, Hou Y, Hu J. Primary pulmonary angiosarcoma was misdiagnosed as IgG4-related disease by needle biopsy: a challenging case report. Indian J Pathol Microbiol. 2025;68(2):415\u20137.","journal-title":"Indian J Pathol Microbiol"},{"issue":"5","key":"6211_CR7","doi-asserted-by":"publisher","first-page":"211","DOI":"10.3892\/ol.2023.13797","volume":"25","author":"Y Lin","year":"2023","unstructured":"Lin Y, Yu H, Wang C, Zhang D. Primary pulmonary angiosarcoma mimicking diffuse pulmonary hemorrhage: a case report. Oncol Lett. 2023;25(5):211.","journal-title":"Oncol Lett"},{"issue":"8","key":"6211_CR8","volume":"13","author":"K Khalid","year":"2021","unstructured":"Khalid K, Khan A, Lomiguen CM, Chin J. Clinical detection of primary pulmonary angiosarcoma. Cureus. 2021;13(8): e17059.","journal-title":"Cureus"},{"issue":"4","key":"6211_CR9","first-page":"367","volume":"12","author":"K Modrzewska","year":"2015","unstructured":"Modrzewska K, Radzikowska E, Szo\u0142kowska M, Oniszh K, Szcz\u0119sna M, Roszkowski-\u015ali\u017c K. Diffuse pulmonary haemorrhage accompanied by haemothorax as a rare presentation of primary lung angiosarcoma. Kardiochir Torakochirurgia Pol. 2015;12(4):367\u201371.","journal-title":"Kardiochir Torakochirurgia Pol"},{"key":"6211_CR10","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.884386","volume":"9","author":"JY Huh","year":"2022","unstructured":"Huh JY, Moon DS, Song JW. Sarcoid-like reaction in patients with malignant tumors: long-term clinical course and outcomes. Front Med. 2022;9: 884386.","journal-title":"Front Med"},{"issue":"5","key":"6211_CR11","doi-asserted-by":"publisher","first-page":"310","DOI":"10.47102\/annals-acadmedsg.2024346","volume":"54","author":"IK Ng","year":"2025","unstructured":"Ng IK, Goh WG, Nashi N, Gollamudi S, Lahiri M, Morgan DJ, et al. Making better clinical decisions: how doctors can recognise and reduce bias and noise in medical practice. Ann Acad Med Singap. 2025;54(5):310\u20133.","journal-title":"Ann Acad Med Singap"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-026-06211-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-06211-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-06211-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:07:47Z","timestamp":1787234867000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13256-026-06211-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,14]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6211"],"URL":"https:\/\/doi.org\/10.1186\/s13256-026-06211-8","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,14]]},"assertion":[{"value":"6 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval was not required for this single case report, in accordance with the institutional\/national policy.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from the patient\u2019s next of kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors of this study have no competing interest to disclose.","order":3,"name":"Ethics","label":"Competing interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"482"}}