Aortic Pleomorphic Sarcoma Presenting With Claudication: A Rare Diagnostic Challenge

Aortic pleomorphic sarcomas are rare, aggressive vascular tumors often presenting with nonspecific symptoms that delay diagnosis. We describe a 53-year-old male who presented with isolated lower extremity claudication. Examination revealed absent pulses in the left leg, and duplex vascular ultrasound showed monophasic flow. CT angiography demonstrated a 48 mm infrarenal abdominal aortic aneurysm extending to the iliac bifurcation, a bulge in the left common iliac artery, and high-grade stenosis in a short segment. The patient underwent surgical repair with a Y-graft. Histopathological analysis confirmed undifferentiated pleomorphic sarcoma with a high Ki67 index (65%) and absence of specific immunohistochemical markers. Postoperative PET-CT revealed metastatic disease involving lungs, liver, and bones. The patient subsequently received systemic chemotherapy. This case highlights the diagnostic challenges of undifferentiated pleomorphic sarcoma when they present with isolated ischemic symptoms rather than signs of malignancy Early recognition through imaging and histopathology is essential, as surgical resection remains the cornerstone of treatment despite poor prognosis.