Aortic arch aneurysm

Case contributed by A.Prof Frank Gaillard

Presentation

Vague symptoms of breathlessness. No chest pain.

Patient Data

Age: 65 years
Gender: Female
Modality: X-ray

Chest x-ray  demonstrates a large rounded opacity projecting from the mediastinum laterally on the left. Note is also made of cardiomegaly and calcific atherosclerotic disease of the arch of the aorta.

Modality: CT

A non-contrast CT (the patient is allergic to contrast) confirms a large saccular out-pouching arising from the left side of the aortic arch.  Turbulent blood flow can be seen within the aneurysm (even on the non-contrast imaging).

Modality: Annotated image

On the frontal and lateral radiographs the outline of the aorta can be traced (red dotted line) and does not clearly blend with the mass projecting towards the right of the mediastinum (blue dotted line). 

When one looks at the CT, it is easy to understand why this is the case. Although the aorta (red dotted line) and aneurysm (blue dotted line) are in continuity, the x-ray beam are tangential to the posterior part of the arch or the aorta (red arrow) and the aneurysm (blue arrow) separately, both therefore casting a silhouette. 

Case Discussion

This case illustrates thoracic aortic aneurysm presenting as a mediastinal mass

The case also illustrates that arterial phase imaging is not required to make the diagnosis - it wasn't performed in this case because of allergy. Arterial imaging helps with diagnosis of complications and characterisation. The aneurysm is probably a false aneurysm although on non-contrast imaging it is not possible to be certain.

Case courtesy of Bob Cook, MD. Western Memorial Regional Hospital Corner Brook, Newfoundland.

PlayAdd to Share

Case Information

rID: 8534
Case created: 9th Feb 2010
Last edited: 10th Feb 2017
Systems: Chest, Vascular
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.