Myeloid sarcoma infiltration of aortic stent-graft causing chronic hemorrhage

To report a rare case of myeloid sarcoma infiltration of an aortic stent-graft causing chronic hemorrhage and mimicking stent-graft infection.

A 90-year-old man presented 8 years after endovascular aneurysm repair with general malaise, nausea, abdominal pain, and hyperbilirubinemia. His inflammatory blood markers were elevated, and an abdominal computed tomography (CT) scan showed unusual fluid and soft tissue collection around the stent-graft. A presumptive diagnosis of stent-graft infection was made, and he was started on intravenous antibiotics because he was not fit for surgery. His condition gradually deteriorated in hospital. Four months later he died of sudden hemodynamic collapse and shock. Postmortem examination revealed large malignant periaortic lymphadenopathy with suggestion of stent-graft infiltration and chronic hemorrhage. Histology of the lymph nodes confirmed myeloid sarcoma.

Soft tissue and fluid collections around an aortic stent-graft on CT are not always indicative of a graft infection; malignant tumors, although rare, should be considered.