A Case of Aortic Intimal Sarcoma Mimicking Atherosclerotic Plaque: Diagnostic Limitations of Fluorodeoxyglucose-positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging

A 66-year-old man presented with upper limb blood pressure. Imaging revealed a mural thrombus extending from the aortic arch to the descending aorta and multiple metastatic lesions. Fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) showed a low FDG uptake, and gadolinium-enhanced magnetic resonance imaging (MRI) ruled out malignancy. Despite progressive aortic luminal stenosis, the patient remained asymptomatic due to embolism. The patient died 22 months later, and an autopsy confirmed aortic intimal sarcoma. This case highlights the diagnostic limitations of imaging for malignancy-related aortic luminal stenosis and provides insights into the management of progressive aortic luminal stenosis when curative revascularization is not feasible.