Descending thoracic aortic aneurysm

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Patient fell with left femur fracture. How to approach this incidental finding? Location, etc. No lateral view was obtained due to fracture of femur.

Patient Data

Age: 88
Gender: Female
X-ray

What is the next study of choice?

 FINDINGS/IMPRESSION:

Heart is normal size.

A 6.5 to 7 cm mass is demonstrated overlying the left hilum, separate from the aortic arch and proximal descending thoracic aorta.
Additional soft tissue density extending beneath the left mainstem bronchus consistent with subcarinal adenopathy.

No peripheral consolidation, pleural fluid or congestive failure demonstrated. No additional pulmonary mass is appreciated on screening AP portable radiograph.

Multiple healed left rib fractures noted. Moderate degenerative
changes involve both shoulders.

Upper bowel gas pattern within normal limits.

OPINION:
Large left perihilar pulmonary mass with subcarinal adenopathy. Given past smoking history, primary lung cancer considered most likely.

CT chest with contrast recommended to additionally assess.
 

Large aneurysms involving the thoracic aorta distal to the subclavian artery takeoff at the arch and at the T8 level at the diaphragmatic hiatus. No evidence of rupture or acute dissection.

Findings ofaneurysms likely consistent with prior trauma given evidence of prior multiple rib fractures and classic locations.

Case Discussion

No interventions performed on the aneurysm.

Read about hilum overlay sign.

One should read up locations of thoracic aortic injury.

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Case information

rID: 40282
Case created: 15th Oct 2015
Last edited: 3rd Dec 2016
Systems: Cardiac, Chest
Inclusion in quiz mode: Included

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