# Aortic malignancy masquerading as infrarenal aortitis: A diagnostic challenge

## TL;DR

A rare aortic cancer was mistaken for an inflammatory condition, highlighting the difficulty in diagnosing such cases and the need for careful evaluation.

## Contribution

This case report presents a rare instance of aortic sarcoma mimicking aortitis, emphasizing the diagnostic challenges and the role of stent grafts in enabling tissue diagnosis.

## Key findings

- Aortic sarcoma can closely resemble aortitis in clinical and imaging features.
- A stent graft facilitated tissue diagnosis in a case initially misdiagnosed as aortitis.
- Diagnostic vigilance is crucial in atypical cases to avoid mismanagement.

## Abstract

Primary retroperitoneal aortic sarcoma is an exceptionally rare malignancy and may closely mimic inflammatory or infectious aortitis on clinical assessment and imaging. An 89-year-old man presented with abdominal pain, weight loss, and periaortic inflammatory change on computed tomography, raising concern for aortitis with possible impending rupture. Urgent endovascular aortic repair was performed. Despite antimicrobial and immunosuppressive therapy, symptoms and radiographic findings progressed. Subsequent computed tomography-guided biopsy demonstrated a high-grade retroperitoneal aortic sarcoma. The presence of the stent graft influenced perceived procedural safety and allowed tissue diagnosis that had initially been deferred. This case highlights the diagnostic challenge posed by malignant aortic disease presenting as presumed aortitis and underscores the importance of maintaining diagnostic vigilance in atypical cases.