Intimal angiosarcoma of the descending aorta presenting as atheroembolism: case report and description of intravascular biopsy.

Aortic sarcoma is a rare entity. In most cases, the diagnosis is established late, owing to the course of the disease, with a median survival time of only a few months. We report the case of a 58-year-old patient with ischemic lesions in the lower limb. The lesions after several investigations were diagnosed by imaging studies (eg, magnetic resonance angiography, contrast-enhanced computed tomography [CT], CT angiography, or positron emission tomography-CT with fluorine-18 fluorodeoxyglucose) as possible primary angiosarcoma of the aorta. It was decided to perform endovascular aortic repair and endovascular biopsy of the lesion. This was chosen as a "palliative" treatment to avoid embolic events, given the presence of metastases, instead of open surgery, which would otherwise have been the treatment of choice. Subsequently, histologic examination confirmed aortic intimal angiosarcoma, and adjuvant chemotherapy was initiated. In the present report, we discuss the clinical presentation, diagnosis, and classification of primary aortic sarcomas. We also critically review the diagnostic and therapeutic management of these patients in previous series of studies to improve their treatment in subsequent cases.

Ligamento arcuato mediano como hallazgo incidental / Median arcuate ligament as an incidental finding

Introducción: debido al uso de técnicas de imagen de alta resolución se ha incrementado el diagnóstico incidental de la compresión del tronco celiaco por el ligamento arcuato mediano. Si tenemos en cuenta que en solo un 1 % de los casos se produce sintomatología, su hallazgo casual puede llevar a diagnósticos erróneos en pacientes con sintomatología a nivel abdominal. Caso clínico:presentamos el caso de un varón de 47 años con dolor abdominal pospandrial secundario a una perforación esofágica que inicialmente pasó desapercibida, e imágenes en angiografía por tomografía computarizada sugestivas de síndrome de ligamento arcuato mediano, con abundante circulación colateral, pero sin signos de sufrimiento de asas ni trombosis arterial. Discusión:el síndrome del ligamento arcuato mediano es una patología muy infrecuente y, en su mayor parte, solo constituye una imagen radiológica; por ello es necesario descartar cualquier otra patología antes de identificarlo como el responsable de cualquier cuadro clínico digestivo.(AU)

Background: due to high resolution imaging techniques there has been an increase in incidental diagnosis of celiac trunk compression by median arcuate ligament. In fact, only 1 % of the cases of abdominal pain are attached to coeliac trunk compression. Therefore, its incidental finding might lead to a misdiagnosis in those patients with abdominal symptoms. Case report:we report a case of a 47 year-old male with abdominal post-pandrial pain, as a result of an esophageal perforation which was initially misdiagnosed, and image techniques suggesting a median arcuate ligament syndrome, with abundant collateral circulation but without signs of intestinal ischemia or arterial thrombosis. Discussion:median arcuate ligament syndrome is very uncommon and it is mainly a radiological image finding. Thus it is needed to rule out any other digestive pathology before median arcuate ligament syndrome is diagnosed in patients with abdominal symptoms.(AU)