1
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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2
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Bartolomé Sánchez A, Inaraja-Pérez GC, Jiménez Elbaile A, Brito MO, Buisán Bardaji JM. Intimal angiosarcoma of the descending aorta presenting as atheroembolism: case report and description of intravascular biopsy. J Vasc Surg Cases Innov Tech 2023; 9:101230. [PMID: 37799831 PMCID: PMC10547730 DOI: 10.1016/j.jvscit.2023.101230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/11/2023] [Indexed: 10/07/2023] Open
Abstract
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.
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Affiliation(s)
| | - Gabriel-Cristian Inaraja-Pérez
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Alfonso Jiménez Elbaile
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Manoela Oliveira Brito
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - José Manuel Buisán Bardaji
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
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3
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Nakamura H, Kanki A, Watanabe H, Ono K, Kuwada N, Saisho S, Nishimura H, Yamamoto A, Tamada T. A case of primary aortic sarcoma with tumor infarction after stent graft placement. Acta Radiol Open 2021; 10:20584601211063360. [PMID: 34900342 PMCID: PMC8664319 DOI: 10.1177/20584601211063360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022] Open
Abstract
Primary aortic sarcoma is a very rare disease, and most primary aortic tumors are
malignant mesenchymal tumors. We present the case of a 62-year-old man with
sudden epigastric and back pain. Contrast-enhanced computed tomography (CT)
revealed a mass lesion about 33.8 mm in diameter, in contact with the left side
of the abdominal aorta. Impending rupture of an abdominal aortic aneurysm was
suspected, so cardiovascular surgery for stent graft placement was performed the
same day. Symptoms immediately improved and CT at 3 months postoperatively
showed a marked decrease in lesion size, but the lesion subsequently grew again.
Fluorodeoxyglucose (FDG)-positron emission tomography/CT was performed due to
the possibility of malignant solid tumor, revealing markedly increased FDG
accumulation (maximum standardized uptake value, 36.95) in the mass lesion.
Primary aortic sarcoma was diagnosed from thoracoscopic biopsy. Here, we report
a primary aortic sarcoma that shrank due to tumor infarction after stent graft
placement, followed by tumor regrowth.
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Affiliation(s)
- Hiroki Nakamura
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Akihiko Kanki
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | | | - Kentarou Ono
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Noriaki Kuwada
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Shinsuke Saisho
- Department of General Thoracic Surgery, Kawasaki Medical School, Kurashiki, Japan
| | | | - Akira Yamamoto
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Tsutomu Tamada
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
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4
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Sharma A, Ojha V, Pandey NN, Sinha M, Malhi AS, Chandrashekhara SH, Kumar S, Sharma G. Stenotic lesions of aorta: Imaging evaluation using multidetector computed tomography angiography. Asian Cardiovasc Thorac Ann 2021; 29:884-892. [PMID: 34102896 DOI: 10.1177/02184923211024094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic involvement can be secondary to various pathologic disease processes. These may result in stenotic or aneurysmal aortic lesions with a varied spectrum of imaging findings including intra-luminal, mural, and periaortic changes along with associated loco-regional or distal changes, depending on the etiology. Multidetector computer tomography with its recent advances has become the frontline imaging modality for the evaluation of aortic pathologies. Comprehensive evaluation of the aortic pathology with simultaneous evaluation of lungs, bones, and visceral organs is possible with a single multidetector computer tomography acquisition. It allows accurate primary diagnosis, identifies important anatomic landmarks and relationships, and identifies associated cardiovascular anomalies. Moreover, it serves as an adjunct in diagnosis of various complications, helps in treatment planning and detection of disease progression during follow-up.
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Affiliation(s)
- Arun Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj N Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Mumun Sinha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder S Malhi
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - S H Chandrashekhara
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Gautam Sharma
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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5
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Gunn AJ, Kalva SP, Majdalany BS, Craft J, Eldrup-Jorgensen J, Ferencik M, Ganguli S, Kendi AT, Khaja MS, Obara P, Russell RR, Sutphin PD, Vijay K, Wang DS, Dill KE. ACR Appropriateness Criteria® Nontraumatic Aortic Disease. J Am Coll Radiol 2021; 18:S106-S118. [PMID: 33958105 DOI: 10.1016/j.jacr.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/16/2023]
Abstract
Nontraumatic aortic disease can be caused by a wide variety of disorders including congenital, inflammatory, infectious, metabolic, neoplastic, and degenerative processes. Imaging examinations such as radiography, ultrasound, echocardiography, catheter-based angiography, CT, MRI, and nuclear medicine examinations are essential for diagnosis, treatment planning, and assessment of therapeutic response. Depending upon the clinical scenario, each of these modalities has strengths and weaknesses. Whenever possible, the selection of a diagnostic imaging examination should be based upon the best available evidence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. The purpose of this document is to assist physicians select the most appropriate diagnostic imaging examination for nontraumatic aortic diseases.
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Affiliation(s)
- Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama, Director, Interventional Oncology, Director, Ambulatory Clinic, Assistant Program Director, Diagnostic Radiology Residency, Assistant Program Director, Interventional Radiology Residency, University of Alabama at Birmingham, Member, American College of Radiology-Radiologic Society of North America Patient Information Committee.
| | - Sanjeeva P Kalva
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts, Chief, Division of Interventional Radiology, Massachusetts General Hospital
| | | | - Jason Craft
- St. Francis Hospital, Catholic Health Services of Long Island, Roslyn, New York, Society for Cardiovascular Magnetic Resonance
| | - Jens Eldrup-Jorgensen
- Tufts University School of Medicine, Boston, Massachusetts, Society for Vascular Surgery
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, Society of Cardiovascular Computed Tomography
| | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota, Director of Nuclear Medicine Therapies at Mayo Clinic Rochester
| | - Minhajuddin S Khaja
- University of Virginia, Charlottesville, Virginia, Vice-Chair ACR Vascular Imaging Panel 2, Program Director, Independent IR Residency, UVA Health
| | - Piotr Obara
- Loyola University Medical Center, Maywood, Illinois
| | - Raymond R Russell
- The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, Nuclear cardiology expert, Program Director, Cardiology Fellowship, Director, Nuclear Cardiology, Director, Cardio-Oncology Program, Rhode Island Hospital
| | | | | | - David S Wang
- Stanford University Medical Center, Stanford, California
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
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6
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Upchurch GR, Escobar GA, Azizzadeh A, Beck AW, Conrad MF, Matsumura JS, Murad MH, Perry RJ, Singh MJ, Veeraswamy RK, Wang GJ. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg 2021; 73:55S-83S. [DOI: 10.1016/j.jvs.2020.05.076] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
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7
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Nishimura T, Sueyoshi E, Tasaki Y, Uetani M. Asymptomatic floating thrombus in the ascending aorta depicted on four-dimensional computed tomography. SAGE Open Med Case Rep 2020; 8:2050313X20971894. [PMID: 33224502 PMCID: PMC7649852 DOI: 10.1177/2050313x20971894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022] Open
Abstract
Aortic mural thrombi of the ascending aorta are rare. If an aortic mural thrombus is dislodged, it can cause various embolic complications, which can sometimes be fatal. Although contrast-enhanced computed tomography (CT) and transesophageal echography are useful for diagnosing aortic mural thrombi, four-dimensional CT (4D-CT) is one of the most useful modalities for both diagnosis and treatment selection in such cases. 4D-CT can be used to evaluate the morphology and mobility of thrombi. Furthermore, it is minimally invasive. To the best of our knowledge, there have not been any reports about 4D-CT being used to depict an asymptomatic ascending aortic thrombus. We report a very unusual case, involving an aortic mural thrombus of the ascending aorta.
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Affiliation(s)
- Takamasa Nishimura
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Eijun Sueyoshi
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yuichi Tasaki
- Department of Cardiovascular Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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8
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Diaconu R, Florescu R, Cornelissen A, Mamdouh A, Schaaps N, von Stillfried S, Boor P, Knüchel-Clarke R, Donoiu I, Vogt F. An unusual case of aortic metastasis from lung cancer. Discoveries (Craiova) 2020; 8:e106. [PMID: 32309623 PMCID: PMC7159821 DOI: 10.15190/d.2020.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In patients with cardiovascular events, such as myocardial infarction or aortic dissection without known risk factors for cardiovascular disease, neoplastic disease should be considered as a differential diagnosis. In this report, we present a case of a 51-year old man with previously undiagnosed non-small lung cancer leading to fatal cardiovascular complications due to hemovascular spread, diagnosed post-mortem. This case illustrates the value of autopsy in unexpected deaths.
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Affiliation(s)
- Rodica Diaconu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
| | - Roberta Florescu
- University Hospital RWTH Aachen, Division of Cardiology, Angiology and Critical Care, Aachen, Germany
| | - Anne Cornelissen
- University Hospital RWTH Aachen, Division of Cardiology, Angiology and Critical Care, Aachen, Germany
| | - Afify Mamdouh
- University Hospital RWTH Aachen, Division of Cardiology, Angiology and Critical Care, Aachen, Germany
| | - Nicole Schaaps
- University Hospital RWTH Aachen, Division of Cardiology, Angiology and Critical Care, Aachen, Germany
| | | | - Peter Boor
- Institute of Pathology, University Hospital Aachen, Germany
| | | | - Ionuț Donoiu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
| | - Felix Vogt
- University Hospital RWTH Aachen, Division of Cardiology, Angiology and Critical Care, Aachen, Germany
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9
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Vacirca A, Faggioli G, Pini R, Freyrie A, Indelicato G, Fenelli C, Bacchi Reggiani ML, Vasuri F, Pasquinelli G, Stella A, Gargiulo M. Predictors of survival in malignant aortic tumors. J Vasc Surg 2019; 71:1771-1780. [PMID: 31862201 DOI: 10.1016/j.jvs.2019.09.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/10/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Malignant aortic tumors (MATs) are exceedingly rare, and a comprehensive review of clinical and therapeutic aspects is lacking in the literature. The aim of this study was to analyze all known cases of MATs and to identify predictors of patients' survival. METHODS All patients diagnosed with an aortic tumor treated in a single center along with all case reports and reviews available in the literature through a specific PubMed search using keywords such as "malignant" and "aorta" or "aortic," "tumor," or "sarcoma" or "angiosarcoma" were analyzed. The tumor's primary location, clinical presentation, histologic subtype, and treatment choice were examined. Survival at 1 year, 3 years, and 5 years and the possible preoperative and operative outcome predictors were evaluated using Kaplan-Meier analysis with a log-rank test and by Cox regression for multivariate analysis. RESULTS In addition to the 5 cases treated in our center, 218 other cases of MAT were reported in the literature from 1873 to 2017. The mean age of the patients was 60.1 ± 11.9 years, and the male to female ratio was 1.59:1. The median overall survival from diagnosis was 8 (7-9) months; 1-, 3-, and 5-year survival rates were 26%, 7.6%, and 3.5%, respectively. Chronic hypertension (P = .03), fever (P = .03), back pain (P = .01), asthenia (P = .04), and signs of peripheral embolization (P = .007) were significant predictors of a poor result. Histologic subtypes had a different impact on survival, with no statistical significance. Compared with other treatment strategies, combined surgical-medical therapy had the best impact on the median survival rate (surgical-medical, 12 [8-24] months; medical, 8 [5-10] months; surgical 7 [2-16] months; no treatment, 2 [0.5-15] months; P = .001). Analyzing exclusively medical approaches, chemotherapy and radiotherapy had the best impact on median survival rate compared with untreated patients (chemotherapy-radiotherapy, 18 [10-26] months; radiotherapy, 16 [8-20] months; chemotherapy, 10 [7-24] months; no medical treatment, 6 [2-16] months; P = .005); these data were not sustained by multivariate analysis. CONCLUSIONS Aortic tumors are a malignant pathologic condition with a short survival rate after initial diagnosis. Survival is further diminished in the presence of clinical factors such as hypertension, fever, back pain, asthenia, and signs of peripheral embolization. Combined surgical and medical treatment, particularly with chemotherapy and radiotherapy, has shown the highest survival rate.
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Affiliation(s)
- Andrea Vacirca
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gianluca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
| | - Rodolfo Pini
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Antonio Freyrie
- Vascular Surgery, University of Parma, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Giuseppe Indelicato
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Cecilia Fenelli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Maria Letizia Bacchi Reggiani
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Francesco Vasuri
- Anatomical Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gianandrea Pasquinelli
- Anatomical Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Andrea Stella
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
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10
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Blanes Ortí PC, Bernal LR, Requejo García L, Hernández MM. Abdominal Aortic Rupture Secondary to Lymphoma Recurrence. Ann Vasc Surg 2019; 58:381.e5-381.e9. [PMID: 30731218 DOI: 10.1016/j.avsg.2018.10.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 11/18/2022]
Abstract
Neoplasias affecting the aorta are usually due to a variety of thoracic and abdominal tumors, which are more common than primary tumors of the aortic wall. Those tumors that can invade the abdominal aorta are usually sarcomas, which are able to mimic, both clinically and radiologically, an aortic disease such as an aneurysm or a dissection. There are few clinical scenarios where surgical resection and aortic repair needs to be performed, and indications have not still been clearly established in the literature. We describe the case of a patient with a periaortic lymphoma who presented an aortic rupture and was successfully treated with an urgent endovascular repair.
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MESH Headings
- Aged
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/pathology
- Aneurysm, False/surgery
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/pathology
- Aorta, Abdominal/surgery
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/etiology
- Aortic Aneurysm, Abdominal/pathology
- Aortic Aneurysm, Abdominal/surgery
- Aortic Rupture/diagnostic imaging
- Aortic Rupture/etiology
- Aortic Rupture/pathology
- Aortic Rupture/surgery
- Aortography/methods
- Blood Vessel Prosthesis Implantation
- Computed Tomography Angiography
- Endovascular Procedures
- Humans
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Neoplasm Invasiveness
- Recurrence
- Treatment Outcome
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Affiliation(s)
- Paula C Blanes Ortí
- Angiology and Vascular Surgery Service, University and Polytechnic La Fe Hospital, Valencia, Spain.
| | - Lucas Ribé Bernal
- Angiology and Vascular Surgery Service, University and Polytechnic La Fe Hospital, Valencia, Spain
| | - Lucía Requejo García
- Angiology and Vascular Surgery Service, University and Polytechnic La Fe Hospital, Valencia, Spain
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11
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Abstract
Computed tomography angiography (CTA) has the ability to evaluate the aortic wall and the lumen easily, quickly, and reproducibly without the need for invasive techniques. The images are isotropic, allowing several reconstructions. When imaging the aorta, CTA has replaced catheter angiography in the diagnosis of acquired disease such as aortoiliac disease, aneurysm, and infectious and inflammatory disease of the aorta.
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Affiliation(s)
- Xhorlina Marko
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, 8900 North Kendall Drive, Miami, FL 33176, USA
| | - Constantino S Peña
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, 8900 North Kendall Drive, Miami, FL 33176, USA.
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12
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Safri LS, Md Noh MSF, Hariz Ramli AR, Md Pauzi SH, Md Idris MA, Harunarashid H. A case of metastatic adenocarcinoma from an unknown primary involving the aortic bifurcation. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:160-162. [PMID: 29942910 PMCID: PMC6012993 DOI: 10.1016/j.jvscit.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/08/2018] [Indexed: 11/26/2022]
Abstract
Aortic malignant neoplasms are rare; these may be primary or secondary (metastatic). Increasing use of cross-sectional imaging has allowed better detection and diagnosis of these conditions. We encountered a young woman presenting with acute abdomen who was found on cross-sectional imaging to have a malignant tumor involving the aortic bifurcation. An en bloc excision of the tumor was performed, with distal aorta reconstruction using an aortoiliac Dacron graft; this was complicated with infection and graft occlusion, necessitating total removal and extra-anatomic bypass. A pathologic diagnosis of metastatic adenocarcinoma involving the aortic bifurcation, with an unknown primary, was made.
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Affiliation(s)
- Lenny Suryani Safri
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
| | | | - Ahmad Rafizi Hariz Ramli
- Department of Surgery, Faculty of Medicine, Universiti Malaya Medical Center, Petaling Jaya, Malaysia
| | - Suria Hayati Md Pauzi
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
| | - Mohamad Azim Md Idris
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
| | - Hanafiah Harunarashid
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
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13
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Abstract
A number of congenital defects and acquired disease processes affect the thoracic aorta, and traditionally, computed tomography (CT) has been the mainstay of imaging, especially in evaluation of the acute aorta. However, recent advances in magnetic resonance (MR) imaging such as electrocardiographically (ECG) triggered breath-hold sequences and ultrafast 3-dimensional MR angiography (MRA) are bringing MR imaging to the forefront of imaging of the thoracic aorta. By providing high-resolution morphological imaging and sophisticated vascular flow analysis for functional data, this modality can provide a comprehensive, reproducible evaluation of the thoracic aorta. In this review, we discuss the role of MR imaging in the evaluation of thoracic aorta pathology along with pertinent examples of aortic abnormalities.
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Affiliation(s)
- John P Lichtenberger
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Derek F Franco
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jason S Kim
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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14
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Kuroda Y, Uchida T, Hayashi J, Sadahiro M. An intra-aortic floating metastatic malignancy of unknown primary origin. Eur J Cardiothorac Surg 2018; 53:477-478. [PMID: 28958067 DOI: 10.1093/ejcts/ezx306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/25/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022] Open
Abstract
A 69-year-old man with sudden strong back pain was transported to our hospital by ambulance. The computed tomography scan revealed an intra-aortic floating mass with a stalk arising from the descending aortic wall, which was thought to be a thrombus. The floating mass displayed the characteristics of a thrombus rather than a neoplastic tumour on magnetic resonance imaging scan. Under extracorporeal circulation, the descending aorta was cut open, and the mass was resected. Subsequently, a stent graft was placed to cover the abnormal aortic intima to prevent recurrent thrombus formation. The pathological diagnosis revealed an adenocarcinoma, not a thrombus. We could not detect the origin of malignancy despite additional examinations. Brain metastasis developed, and the patient died of recurrent pneumonia and urinary tract infection. These findings emphasize the importance of a precise plan of action for rare diseases.
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Affiliation(s)
- Yoshinori Kuroda
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tetsuro Uchida
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Jun Hayashi
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Mitsuaki Sadahiro
- Division of Cardiovascular Surgery, Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan
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15
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Pucci A, De Martino A, Levantino M, Berchiolli R, Basolo F, Bortolotti U. Intimal Sarcoma of the Descending Aorta Mimicking Aortitis. AORTA (STAMFORD, CONN.) 2016; 4:142-145. [PMID: 28097198 PMCID: PMC5217733 DOI: 10.12945/j.aorta.2016.16.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/29/2016] [Indexed: 12/17/2022]
Abstract
We describe a 74-year-old male patient with an intimal sarcoma of the descending aorta mimicking aortitis. The patient presented with lower back pain, fever, and increased C-reactive protein, erythrocyte sedimentation rate, and immunoglobulin G4 (IgG4) serum levels, together with Staphylococcus epidermidis-positive blood cultures. These findings, together with evidence of a 49-mm pseudoaneurysm of the descending thoracic aorta, caused us to suspect aortitis. However, postoperative histology and immunohistochemistry demonstrated the presence of an intimal aortic sarcoma. At the 8-month follow-up, local recurrence of the neoplasm and lung metastases were noted.
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Affiliation(s)
- Angela Pucci
- Division of Pathology, University Hospital, Pisa, Italy
| | | | | | | | - Fulvio Basolo
- Division of Pathology, University Hospital, Pisa, Italy
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16
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Toyoda Y, Ozaki R, Kishi J, Hanibuchi M, Kinoshita K, Tezuka T, Goto H, Ono H, Nagai K, Bando Y, Doi T, Nishioka Y. An Autopsy Case of Aortic Intimal Sarcoma Initially Diagnosed as Polyarteritis Nodosa. Intern Med 2016; 55:3191-3195. [PMID: 27803418 PMCID: PMC5140873 DOI: 10.2169/internalmedicine.55.7152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A 61-year-old man had hypertension with stenosis in the left renal artery. When his fever, abdominal pain, and renal dysfunction progressed, he was admitted to our hospital. He was diagnosed with polyarthritis nodosa. His renal function rapidly deteriorated despite immunosuppressive therapy. His digestive tract perforated twice, and he subsequently died. An autopsy revealed that aortic intimal sarcoma caused stenosis in multiple arteries. Both polyarteritis nodosa and aortic intimal sarcoma are very rare diseases and the diagnoses are very difficult. It is very important to consider these entities when making a differential diagnosis of vasculitis.
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Affiliation(s)
- Yuko Toyoda
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
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17
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Kohnken R, Durham JA, Premanandan C, Scansen BA. Aortic chondroid neoplasia in two Labrador Retriever dogs. J Vet Cardiol 2015; 17:314-20. [PMID: 26521222 DOI: 10.1016/j.jvc.2015.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 12/27/2022]
Abstract
In the same week, two Labrador Retriever dogs presented to The Ohio State University Veterinary Medical Center for cardiac evaluation. The presenting signs in both dogs included: weight loss, weakness, lethargy, and decreased femoral pulses. The first dog presented in cardiogenic shock and biventricular congestive heart failure, which initially responded to treatment; however, the dog was euthanized due to deteriorating clinical condition. In contrast, the second dog had a milder clinical course without signs of congestive heart failure, and remained stable over the 2-month period of clinical evaluation prior to euthanasia. Echocardiographic evaluation revealed a dilated cardiomyopathy phenotype in the first dog, while a space-occupying intraluminal mass originating at the aortic valve with preserved left ventricular systolic function was observed in the second dog. At autopsy, each dog had a large obstructive luminal mass affecting the ascending aorta and arch. Histopathology revealed that the mass in the first dog was consistent with a benign chondroma, while in the second dog the morphologic characteristics, mitotic activity, and infiltrative growth justified a diagnosis of chondrosarcoma. This report presents the contrasting clinical disease progression and findings in two dogs with aortic neoplasia, with a proposed pathogenesis of cardiac failure secondary to aortic neoplasia.
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Affiliation(s)
- R Kohnken
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon L Tharp St, Columbus, OH 43210, USA.
| | - J A Durham
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon L Tharp St, Columbus, OH 43210, USA
| | - C Premanandan
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon L Tharp St, Columbus, OH 43210, USA
| | - B A Scansen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon L Tharp St, Columbus, OH 43210, USA
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18
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Manlove W, Raptis CA, Bhalla S. Pitfalls in computed tomography of the aorta. Semin Roentgenol 2015; 50:229-34. [PMID: 26002244 DOI: 10.1053/j.ro.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Whitney Manlove
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO.
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19
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Ugurlucan M, Barburoglu M, Sayin OA, Beyaz MO, Ekiz F, Acunas B, Dayioglu E, Alpagut U. Endovascular Treatment for Primary Aortic Angiosarcoma to Relieve Thoracic Aortic Stenosis. Ann Vasc Surg 2014; 28:1799.e5-8. [DOI: 10.1016/j.avsg.2014.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/03/2014] [Accepted: 05/08/2014] [Indexed: 12/27/2022]
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20
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Rusthoven CG, Liu AK, Bui MM, Schefter TE, Elias AD, Lu X, Gonzalez RJ. Sarcomas of the Aorta: A Systematic Review and Pooled Analysis of Published Reports. Ann Vasc Surg 2014; 28:515-25. [DOI: 10.1016/j.avsg.2013.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 12/19/2022]
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21
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Stein E, Mueller GC, Sundaram B. Thoracic Aorta (Multidetector Computed Tomography and Magnetic Resonance Evaluation). Radiol Clin North Am 2014; 52:195-217. [DOI: 10.1016/j.rcl.2013.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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