Incidental floating aortic mass as the initial presentation of primary aortic sarcoma

Primary aortic tumours are extremely rare, with fewer than 250 cases reported in the literature. We present the case of an octogenarian man with an incidental aortic mass detected on CT, initially misdiagnosed as a thrombus. Its atypical radiological features-large size in a high-flow area without an associated aneurysm-and persistence despite anticoagulation raised suspicion of an aortic tumour. However, imaging studies (positron emission tomography-CT and magnetic resonance angiography) were inconclusive. A definitive diagnosis of primary aortic sarcoma was made postmortem through histological examination of an embolic fragment obtained during emergency surgery for acute lower-limb arterial ischaemia, a fatal complication that ultimately led to the patient's death. This case emphasises the importance of maintaining a high index of clinical suspicion for aortic tumours and highlights the critical need for further evidence and case reports to improve the multidisciplinary management of this exceptionally rare and highly fatal condition.