Xie Xiu-Jing, Jiang Tian-An, Zhao Qi-Yu
Department of Ultrasound Medicine, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou 310003, Zhejiang Province, China.
World J Clin Cases. 2021 Nov 6;9(31):9652-9661. doi: 10.12998/wjcc.v9.i31.9652.
Primary mediastinal leiomyosarcomas are extremely rare. We report a case of leiomyosarcoma around the thoracic and abdominal aorta, mimicking an aortic hematoma, and discuss the diagnostic value of ultrasound.
A 63-year-old female was hospitalized for abdominal pain. Initial computed tomography angiography revealed an enhanced mass around the lower thoracic and upper abdominal aorta. Aortic hematoma was strongly suspected, and stents were placed by interventional surgery. About 1 mo postoperatively, the patient was re-hospitalized because of progressive abdominal pain. Ultrasound showed that the mass had a heterogeneous echo. In contrast-enhanced ultrasound, the hyperechoic regions were filled with contrast medium after the aortic region was, indicating that the blood supply was abundant but had no direct connection with the aorta. There was no obvious contrast medium-filling in the hypoechoic area. These findings were similar to those of malignant tumors with liquefaction and necrosis. Positron emission tomography/computed tomography confirmed that the mass had a high metabolic signal similar to that of a malignant tumor. Leiomyosarcoma was confirmed by postoperative pathology.
Symptoms of mediastinal leiomyosarcoma surrounding the aorta may mimic aortic hematoma. Contrast-enhanced ultrasound can provide valuable and unique diagnostic clues.
原发性纵隔平滑肌肉瘤极为罕见。我们报告一例发生于胸腹部主动脉周围的平滑肌肉瘤，其表现类似主动脉血肿，并探讨超声的诊断价值。
一名63岁女性因腹痛入院。初始计算机断层扫描血管造影显示胸下段和腹上段主动脉周围有一强化肿块。强烈怀疑为主动脉血肿，并通过介入手术置入支架。术后约1个月，患者因进行性腹痛再次入院。超声显示肿块回声不均匀。在超声造影中，高回声区域在主动脉区域之后被造影剂充盈，表明血供丰富但与主动脉无直接连接。低回声区无明显造影剂充盈。这些表现与伴有液化和坏死的恶性肿瘤相似。正电子发射断层扫描/计算机断层扫描证实肿块具有与恶性肿瘤相似的高代谢信号。术后病理证实为平滑肌肉瘤。
主动脉周围纵隔平滑肌肉瘤的症状可能类似主动脉血肿。超声造影可提供有价值且独特的诊断线索。
