Primary angiosarcoma arising in the sinus of Valsalva: A case report

Figures

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  Fig. 1. Preoperative computed tomography for the initial surgical procedure. An aneurysm measuring 53 × 48 mm is seen in proximity to the right aspect of the left atrium (white arrow), juxtaposed with the superior dorsal aspect of the right atrium and connected through a tubular structure originating from the sinus of Valsalva in the lower extremity of the ostium of the right coronary artery. Concomitantly, a fistulous communication is seen extending into the right atrium.

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  Fig. 2. Postoperative computed tomography for the initial surgical procedure The aneurysm within the sinus of Valsalva appears thrombosed and devoid of any discernible contrast enhancement. Furthermore, the bypass graft originating from the ascending aorta and directed toward the second right coronary artery remains open and unobstructed.

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  Fig. 3. Contrast-enhanced chest computed tomography (CT). In the initial postoperative CT, the aneurysm had a diameter of 40 × 47 mm (A). However, a conspicuous aneurysm, measuring 54 × 64 mm in diameter (B), can be seen within the sinus of Valsalva and appears conspicuously devoid of any appreciable contrast enhancement. CT, computed tomography.

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  Fig. 4. Surgical findings. The aneurysm, measuring approximately 6 cm in diameter, is situated on the right anterior facade of the right coronary artery ostium. The aneurysmal wall was excised, followed by meticulous evacuation of the intraluminal thrombus. Further examination of the aneurysmal cavity yielded no evidence of hemodynamic communication with the aorta, leading to the conclusion of a noncommunicating state.

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  Fig. 5. Pathological findings. Atypical cellular entities associated with the intimal surface of the aorta are discernible within the pathological domain. A subset of these atypical cells coalesced to form structures similar to the vascular lumen (hematoxylin and eosin stain, ×200).