A Case of Upper Limb Arterial Embolization Due to Aortic Arch Intimal Sarcoma

Abstract

A 72-year-old man was referred to our hospital because of left upper limb pain. Contrast-enhanced computed tomography showed occlusion of the left brachial artery and the masses in the aortic arch, which were suspected to be thoracic aortic thrombi. We performed emergency thrombectomy of the left brachial artery. On the following day, the patient developed a walking disorder and dysarthria. Head magnetic resonance imaging (MRI) showed cerebral infarction in the cerebellum and occipital lobe. We administered anticoagulation therapy as treatment of cerebral infarction. One-hundred four days after operation, the patient developed higher cortical dysfunction. Head MRI showed brain tumors and an abscess in the left cerebrum and cerebral ventricle. Contrast-enhanced computed tomography showed the rapid growth of the masses in the aortic arch, and infarct regions in the left adrenal gland, spleen, and kidneys. Systemic metastasis of an intraluminal tumor was suspected. The patient was received palliative care and died 111 days after the surgery. An autopsy was performed. The white tumor had grown into the aortic lumen, like a polypoid lesion. The pathological diagnosis was intimal sarcoma of the aorta, and there were multiple metastatic lesions in the brain, spleen, kidneys, and adrenal gland. Aortic intimal sarcoma is a very rare disease. However, we should not exclude the possibility that acute arterial occlusive disease can be caused by an intraluminal tumor.