Figure 1. Chest radiograph displays mild CHF, prominent vascular markings, and a large thoracic aneurysm.
Figure 2. Panel A: Computerized tomography angiography (CTA) with contrast displays an aneurysm of the aortic measuring 6.8 cm with eccentric thrombi. Panel B: CTA also shows an aneurysm of the descending aorta measuring 6 cm across with eccentric thrombi. Panel C: CTA demonstrates a tortuous descending aorta displayed by the curving of the descending aorta as it transitions to the abdominal aorta.
A 94-year-old Spanish-speaking woman presented to the hospital with intermittent episodes of dyspnea and abdominal pain for one week. Her past medical history was notable for 30 pack-year smoking history and hypertension, which was reportedly controlled with medical therapy. Physical exam showed trace peripheral edema bilaterally, intact peripheral pulses, and a mild abdominal bruit. Work up at the emergency department revealed a non-ST elevation myocardial infarction with troponin T of 0.34 ng/mL but no ST-wave abnormality on electrocardiography. Chest x-ray displayed an incidental thoracic aneurysm (Figure 1). Chest computed tomography with contrast demonstrated a continuous aneurysm of the aortic arch and descending thoracic aorta with diameters measuring 6.8 cm and 6 cm, respectively (Figure 2A and 2B). Eccentric thrombi are noted in the aortic arch and the descending aorta. Interestingly, the distal descending thoracic aorta curves as it transitions to the abdominal aorta, which is evidence of a tortuous descending aorta (Figure 2C). The patient declined both invasive and non-invasive treatment and left the hospital against medical advice one day after admission.
Melvin Parasram MS1, Lea McKinnon MD2, Iwan Nyotowidjojo MD3, and Kareem Ahmad MD4
1Midwestern University: Arizona College of Osteopathic Medicine, Glendale, AZ USA
2Departments of Radiology, 3Internal Medicine and 4Pulmonary and Critical Care, Banner University Medical Center - Tucson, Tucson, AZ USA
Cite as: Parasram M, McKinnon L, Nyotowidjojo I, Ahmad K. Medical image of the week: atherosclerotic aneurysm of aortic arch and descending thoracic aorta. Southwest J Pulm Crit Care. 2016;12(2):46-7. doi: http://dx.doi.org/10.13175/swjpcc155-15 PDF