Evaluating Endoleaks in the Dermatology Office
We report the case of a 69-year-old woman who was referred to our dermatology office by her primary care physician for evaluation of a subcutaneous mass overlying the right mid sternum, which was a suspected lipoma. The mass was asymptomatic and had been present for approximately 2 weeks. The patient had undergone an aortic valve replacement approximately 2.5 years prior for treatment of an ascending aortic aneurysm. Physical examination revealed a mass located at the site of the thoracotomy scar. She was referred for an ultrasound and computed tomography angiography. Results of computed tomography angiography were consistent with a type V endoleak, and the patient was then referred to a cardiothoracic surgeon for treatment. Our case represents an unusual entity for presentation at a dermatology clinic, but endoleaks can have dire consequences if they are not recognized and treated appropriately. Dermatologists should be aware of the clinical presentation of endoleaks and this article explains the causes.
Practice Points
- An endoleak should be considered in any patient with a thoracic subcutaneous mass and history of aneurysm repair.
- Order imaging when an endoleak is suspected, including computed tomography angiography. Endoleaks can result in substantial morbidity and mortality if they are not recognized and treated appropriately.
- Dermatologists should be familiar with and able to recognize endoleaks, as patients may present to a dermatologist for evaluation of a subcutaneous mass that proves to be an endoleak.
Conclusion
Endoleaks are common complications of EVARs. Dermatologists may encounter endoleaks that have been misdiagnosed as benign subcutaneous masses such as lipomas. It is imperative that dermatologists are aware of endoleaks, and patients who present with subcutaneous thoracic masses with a history of aneurysm repair require imaging, including computed tomography angiography, and referral to a cardiothoracic surgeon if appropriate.
