Aortic Sarcoma Mimicking a Thrombus Filling Vascular Lumen: A Rare Cause of Cerebral Infarction

Introduction- Primary aortic sarcoma is a very rare cause of stroke. Only about 10 cases of cerebral infarction related to aortic sarcoma have been reported in the literatures since the first description in 1873. We report a case of aortic sarcoma causing a cerebral infarction. Case report- A 20-year old woman presented with an acute onset of global aphasia and right-sided weakness. She had no known vascular risk factors. Magnetic resonance imaging of the brain revealed a large infarction in the left middle cerebral artery territory; and magnetic resonance angiography showed an occlusion of the left middle cerebral artery. No embolic sources were demonstrated in the echocardiography and 24-hour Holter monitoring. Coagulation laboratory tests including D-dimer, prothrombin time, and activated partial thromboplastin time were within normal ranges. Computed tomography (CT) angiography showed a large low-density lesionwhich partially filled lumens of the aortic arch, left common carotid artery, and right bracheocephalic trunk. Initially, this vascular lesion on the CT angiography was interpreted as a large thrombus, and the patient was anti-coagulated with warfarin. Her aphasia and weakness showed improving course. Two months later, she developed a transient left-sided weakness and orthostatic syncope. Her follow-up CT angiography showed progression of the low-density lesion in the aortic arch which extended to both distal internal carotid artery and left vertebral artery. She underwent a debulking surgery with bypass: ascending aorta was connected with the left subclavian artery and with right distal common carotid artery.The pathological study of the biopsied vascular lesion demonstrated a low-grade aortic intimal sarcoma. Conclusion- Primary aortic sarcoma is an extremely rare cause of stroke. This sarcoma may be misinterpreted as a thrombus filling vascular lumen on CT angiography, but no elevation of D-dimer is incompatible with a large thrombus. The final diagnosis can be made by surgical biopsy. Disclosure: Dr. Kim has nothing to disclose. Dr. Jeon has nothing to disclose. Dr. Park has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Kwon has nothing to disclose.