PMC8418191_01
Axial nonenhanced CT images (a) showing a crescent-shaped thickening of aortic wall with the same attenuation as that of the lumen and intimal flap. CTA (c and d) showing an intimal flap and expanded false lumen with slight enhancement, and correspond reconstructed image (d) showing a mass-like false lumen, which was interpreted by radiologists as IMH.
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Chest nonenhanced computed tomography (CT) was performed, which showed crescent-shaped thickening of the thoracic aorta wall with the same attenuation as that of the lumen and linear calcification ingression (Figure 1a). Computed tomography angiography (CTA) revealed an intimal flap and expanded false lumen with slight enhancement (Figure 1b-d).
Digital subtraction angiography image showing mild stenosis in the thoracic aortic lesion without an obvious intimal flap (a) and the implanted stent (b).
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Digital subtraction angiography showed mild stenosis in the thoracic aortic lesion without an obvious intimal flap (Figure 2a). Completion angiography demonstrated that the thoracic aorta and branches were patent, with no obvious endoleak or extravasation (Figure 2b).
Axial nonenhanced CT image (a) and CTA (b-d) showing enlargement of the false lumen three months after stent implantation, with nonhomogeneous enhancement and mediastinal extensions of the false lumen, which was interpreted by radiologists in our hospital and other medical centers during follow-up as an endoleak and periaortic hematoma.
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Three months after endovascular stent graft implantation, follow-up CTA (Figure 3) showed enlargement of the false lumen with nonhomogeneous enhancement and mediastinal extensions.
Magnetic resonance imaging showing gradual enlargement of false lumen with mediastinal extensions and a new lesion in the azygos vein. T1WI image (a) and T2WI image (d) showing the heterogeneous of "false lumen" with bleeding area (green arrow). Contrast-enhanced T1WI image (b) showing a nonhomogeneous enhancement of the "false lumen," which correspond to the hyperintense regions in DWI (b = 800 s/mm2) image (c).
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Subsequent magnetic resonance imaging (Figure 4) showed gradual enlargement of the false lumen with mediastinal extensions and new lesions in the azygos vein.
Histopathology of aortic tissues showed that the tumor was composed of malignant spindle cells and demonstrated nuclear pleomorphism and atypia (hematoxylin and eosin staining x200).
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Histopathological evaluation indicated an intimal sarcoma (Figure 5).