Massive thoracic aortic aneurysm

Case contributed by Henry Knipe


Mild chest discomfort for a few months.

Patient Data

Age: 70 years
Gender: Male

Ectatic and superiorly positioned aortic arch with widening of the distal descending aortic shadow. Lungs and pleural spaces are clear. Cardiac silhouette is probably enlarged. Left apical airspace opacity. 

Massive thoracic aortic aneurysm involving the ascending aorta, aortic arch, and proximal descending aorta. Dilatation is most marked at the ascending aorta, which measures up to 10 mm. Atheromatous plaque in the distal descending thoracic and thoraco-abdominal sections.

Pericardial effusion. Left upper lobe airspace opacity (aspiration +/- infection). Left lower lobe atelectasis. 

Case Discussion

Thoracic aortic aneurysms are most often asymptomatic but can occasionally present with symptoms. Risk of aortic dissection and rupture increases with dilatation beyond 6 cm, and this aneurysm being up to 10 cm in diameter is at very high risk of rupture and requires urgent repair. 

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