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Ann Thorac Surg 2007;83:e1
© 2007 The Society of Thoracic Surgeons

Images in Cardiothoracic Surgery

Primary Sarcoma of the Thoracic Aorta

Nicholas T. Kouchoukos, MD*, Paolo Masetti, MD

Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St. Louis, Missouri

* Address correspondence to Dr Kouchoukos, Cardiac, Vascular and Thoracic Surgery, Inc, Missouri Baptist Medical Center, 3009 North Ballas Rd, Suite 266C, St. Louis, MO 63131. (Email: ntkouch{at}aol.com).

A 37-year-old man underwent a craniotomy for a symptomatic right temporal lobe mass. While recovering, he had ischemic changes develop in the fingers of his right hand. A computed tomographic scan of the chest demonstrated two masses in the thoracic aorta, one near the origin of the innominate artery (Fig 1) and the other in the proximal descending aorta (Fig 2). Transesophageal echocardiography demonstrated a pedunculated mass in the proximal descending aorta (Fig 3). Because of the patient’s young age and a history of two embolic episodes, resection of the ascending aorta, aortic arch, and the proximal one-half of the descending thoracic aorta was performed through a bilateral anterior thoracotomy [1]. The excised aortic segment (Fig 4), which contained both tumor masses, was replaced with a polyester aortic graft containing three branches that were anastomosed to the innominate, left carotid and left subclavian arteries. Microscopic examination of the aorta demonstrated sarcoma at all of the margins. The neoplastic cells were positive for two endothelial markers suggestive of epithelioid angiosarcoma. The patient recovered uneventfully and received chemotherapy, but expired 7 months postoperatively of cerebral metastases.


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Figure 4
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Primary tumors of the aorta are unusual and are seldom diagnosed antemortem. Patients with tumors that primarily involve the intima present with symptoms referable to thromboembolic metastases. These emboli are most commonly found in the mesenteric arteries and are often fatal. Although experience with adjuvant therapy is limited, chemotherapy and radiation therapy have not provided substantial therapeutic benefit.


   References
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 References
 

  1. Rokkas CK, Kouchoukos NT. Single-stage extensive replacement of the thoracic aorta: the arch-first technique J Thorac and Cardiovasc Surg 1999;117:99-105.[Abstract/Free Full Text]



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