Fernández-Trujillo Liliana, Buenaventura Daisy C, Sua Luz F
Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology, Fundación Valle del Lili, Av. Simón Bolívar. Kra. 98 # 18-49. Torre 6, 4th Floor, Cali, 760032, Colombia.
Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.
J Med Case Rep. 2020 Nov 21;14(1):226. doi: 10.1186/s13256-020-02542-2.
Primary malignant tumors of the aorta are extremely rare. They are frequently located in the abdominal aorta, followed by the thoracic aorta. Sarcomas are the most common histological type. These tumors originate from the middle or intimal layer, the latter being the most common. Symptoms and radiological findings are generally nonspecific. Since their growth is endovascular, embolic phenomena can occur leading to occlusive signs and symptoms.
We describe the case of a 75-year-old Hispanic man, a former tobacco smoker, with a history of pain and epigastric tenderness, dysphagia, and weight loss of approximately 6 kg. A thorax computed tomography scan showed a mass within the posterior mediastinum with poorly defined borders and heterogeneous density, located between thoracic vertebra 5-8, with a size of 78 × 53 × 76 mm, with left main bronchus compression. Endobronchial ultrasound-guided transbronchial needle aspiration was performed; it found an extrinsic posterior compression of the left main bronchus with no endobronchial injury. An intimal angiosarcoma of the thoracic aorta was diagnosed.
Tumors of the aorta are rare and difficult to diagnose; they are a challenge during the diagnosis, since they usually require open surgical procedures. Endobronchial ultrasound-guided transbronchial needle aspiration associated with rapid on-site examination offered, in this case, the possibility of a successful diagnosis, avoiding major procedures. This is the first case reported in the literature of an intimal angiosarcoma of the thoracic aorta diagnosed using endobronchial ultrasound-guided transbronchial needle aspiration.
主动脉原发性恶性肿瘤极为罕见。它们常位于腹主动脉，其次是胸主动脉。肉瘤是最常见的组织学类型。这些肿瘤起源于中层或内膜层，以后者最为常见。症状和影像学表现通常不具有特异性。由于其生长是血管内的，可发生栓塞现象，导致闭塞性体征和症状。
我们描述了一名75岁的西班牙裔男性病例，他曾吸烟，有疼痛、上腹部压痛、吞咽困难和体重减轻约6公斤的病史。胸部计算机断层扫描显示后纵隔内有一肿块，边界不清，密度不均匀，位于第5至8胸椎之间，大小为78×53×76毫米，压迫左主支气管。进行了支气管内超声引导下经支气管针吸活检；发现左主支气管有外在性后压，无支气管内损伤。诊断为胸主动脉内膜血管肉瘤。
主动脉肿瘤罕见且难以诊断；在诊断过程中是一项挑战，因为通常需要开放手术。在本病例中，支气管内超声引导下经支气管针吸活检联合快速现场检查提供了成功诊断的可能性，避免了大手术。这是文献中首例使用支气管内超声引导下经支气管针吸活检诊断胸主动脉内膜血管肉瘤的病例。
