Descending thoracic aortic aneurysm

Case contributed by Jayanth Keshavamurthy


Patient fell with left femur fracture.

Patient Data

Age: 90 years
Gender: Female

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.


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

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 of aneurysms 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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