Large thoracic aortic aneurysm

Case contributed by Craig Hacking

Presentation

Acute chest pain and hypertension.

Patient Data

Age: 85 years
Gender: Male
x_ray

Large dilated tortuous aortic arch and descending aorta with mass effect on the trachea (displacing it to the left and mildly narrowing it). Despite rotation of the patient to the right, there is some mediastinal shift to the left.

Increased interstitial markings throughout the lungs. Left apical pleural capping.

Case Discussion

The patient was referred urgently to a tertiary cardiothoracic and vascular surgical unit where a CT (not available) demonstrated a massive Stanford type A aortic dissection and aneurysm. The dissection arose from the aortic root, extended into the brachiocephalic trunk and terminated in the abdominal aorta at the level of the celiac trunk. The patient was a known poorly controlled hypertensive.

After discussion with the family, non-operative management and antihypertensive medication were decided as the most appropriate treatment and the patient died soon after.

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