Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2021; 9(31): 9652-9661
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9652
Diagnostic value of contrast-enhanced ultrasonography in mediastinal leiomyosarcoma mimicking aortic hematoma: A case report and review of literature
Xiu-Jing Xie, Tian-An Jiang, Qi-Yu Zhao
Xiu-Jing Xie, Tian-An Jiang, Qi-Yu Zhao, Department of Ultrasound Medicine, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou 310003, Zhejiang Province, China
Author contributions: Xie XJ drafted the manuscript, collected the data, and reviewed the literature; Jiang TA performed the histological examination and reviewed the manuscript; Zhao QY made intellectual contributions; All authors approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient or the individual authorized by the patient for publication of any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi-Yu Zhao, PhD, Doctor, Department of Ultrasound Medicine, Zhejiang University School of Medicine First Affiliated Hospital, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. derman2000@zju.edu.cn
Received: May 23, 2021
Peer-review started: May 23, 2021
First decision: June 25, 2021
Revised: July 18, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: November 6, 2021
Processing time: 159 Days and 0.3 Hours
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

Symptoms of mediastinal leiomyosarcoma surrounding the aorta may mimic aortic hematoma. Contrast-enhanced ultrasound can provide valuable and unique diagnostic clues.

Keywords: Mediastinal; Leiomyosarcoma; Aortic hematoma; Contrast-enhanced ultrasonography; Case report

Core Tip: This study not only reports a case of leiomyosarcoma around the thoracic and abdominal aorta, mimicking an aortic hematoma, but also proposes a new diagnostic strategy. Diagnosis of leiomyosarcomas of the aorta is always challenging because of its relatively low incidence as well as its similar clinical presentation and computed tomography angiography features to an aortic hematoma. Ultrasound and contrast-enhanced ultrasound can provide valuable and unique diagnostic clues. If the acoustic characteristics are abnormal, it is recommended that tumor detection be improved. We believe this strategy can minimize the risk of missed diagnosis and additional medical costs.