PMC8107686_01
(a) Contrast-enhanced CT scan shows a paravertebral soft tissue mass encasing the thoracic descending aorta with suspicious infiltration of the aortic wall (black arrowhead); (b) further 18F-FDG PET/CT shows intense radiopharmaceutical uptake both within the soft tissue tumor (black arrowhead) and within the 9th thoracic vertebra (white arrowhead); (c) contrast-enhanced MRI T1-weighted image confirms infiltration of the aortic wall (white arrowhead) and (d) heterogeneous contrast enhancement both within the soft tissue tumor (black arrowhead) and within the 9th thoracic vertebra (white arrowhead).
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F1
The patient underwent a multiphasic abdominal CT scan which confirmed urolithiasis and showed a 25 x 19 mm paravertebral soft tissue lesion anterior to 9th thoracic vertebrae (T9), encasing the descending thoracic aorta (Figure 1a). Spinal magnetic resonance imaging (MRI) confirmed an extensive T9 bone involvement and a focal infiltration of the aortic wall (Figures 1c,d). 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) showed intense radiopharmaceutical uptake and excluded distant metastases (Figure 1b).
(a) The scheme detailed the side-biting clamp that allowed the aortic graft to be anatomised without interrupting peripheral blood flow; (b) left thoracotomy shows the first surgical step where the aorta was bypassed and transected.
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F2
The infiltrated aortic segment (8 cm-length) was therefore stapled and transected (Figure 2).
(a) Open posterior approach. The figures show the results of a triple en bloc vertebrectomy. Pedicle screws were inserted at two levels above and two levels below the pathologic vertebrae; (b) Sagittal CT scan. The figure shows the final result after tumor removal and 360  fixation. Instrumentation is radiolucent to consent radiologic follow-up.
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F3
Titanium screws were then replaced with carbon fiber screws (Figure 3).