Bleeding sarcoma of the aorta mimicking a symptomatic aneurysm

MRI (A) and contrast enhanced CT (B) pictures of the aorta show an aneurysm of 9.7 × 8.0 cm located on the left lateral aspect of the lower descending aorta. The presence of fluid in the left pleural space was suggestive of a leaking aortic aneurysm.

A, Three months after endoprosthetic treatment, MRI (T1 after gadolinium) of the aorta was made under suspicion of endoleakage. This scan shows a heterogeneous and lobulated mass of 12.7 × 9.4 cm located in the lateral aspect of the aortic wall bulging into the left pleural space. B, Three months after endoprosthetic treatment, PET scan reveals high uptake in the aortic wall, which looks similar to the corresponding CT and MRI images. The high uptake in this case is an indicator of malignant disease and would not be seen in a leaking symptomatic aneurysm.

Six months after tumor resection, thoracic and abdominal CT was repeated to look for evidence of recurrent disease. The scan shows residual pleural fluid at the left side without any signs of pleural metastases. Furthermore, herniation of part of the stomach is depicted as a result of resection and reconstruction of the left hemidiaphragm.

Three months after endoprosthetic treatment, contrast-enhanced CT of the aorta was made under suspicion of endoleakage. This picture shows a heterogeneous and lobulated mass of 12.7 × 9.4 cm located in the lateral aspect of the aortic wall, bulging into the left pleural space, but there is no sign of contrast extravasation suggestive of endoleakage.