Sarcoid aortitis presenting as an ascending aortic mass mimicking intramural haematoma and complicated by retrograde aortic dissection: a case report

Background: Sarcoidosis is a multi-system disorder characterized by non-caseating granulomatous infiltration, commonly affecting the lungs. Cardiac involvement is rare but potentially life-threatening. Aortitis in sarcoidosis is extremely rare and scarcely reported in the literature. Case summary: We report a unique case of a 51-year-old female patient with multi-system extra-cardiac sarcoidosis who was referred for cardiac magnetic resonance imaging (CMR) to exclude cardiac sarcoid involvement. Imaging revealed a retrograde Stanford Type A aortic dissection with an infiltrative mass engulfing the ascending aorta, initially presumed to represent an intramural haematoma (IMH). However, detailed CMR tissue characterization demonstrated findings inconsistent with IMH and more indicative of inflammatory activity of the ascending aortic wall. Discussion: This case highlights the rare presentation of sarcoid aortitis masquerading as IMH on initial imaging, underscoring the importance of advanced tissue characterization in atypical aortic pathology and the potentially catastrophic complications of granulomatous vascular involvement.