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CASE REPORT
Year : 2020  |  Volume : 18  |  Issue : 1  |  Page : 62-63

Right middle and lower lobe collapse by an ascending thoracic aortic aneurysm


Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission08-Aug-2019
Date of Decision30-Aug-2019
Date of Acceptance31-Aug-2019
Date of Web Publication03-Feb-2020

Correspondence Address:
Dr. Darpanarayan Hazra
Department of Emergency Medicine, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_31_19

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  Abstract 

We report a case of a 60-year-old male patient who presented to the Emergency Department of Christian Medical College, Vellore, with a history of right-sided pleuritic chest pain. Thoracic aortic aneurysms are usually asymptomatic unless any complication occurs (e.g., dissection, rupture) or an imaging study has been performed demonstrating the aneurysm. Chest radiograph of this patient showed collapse of right main bronchus due to an aneurysm, which to our knowledge has not been previously reported in literature.

Keywords: Aneurysm, aortic aneurysm, thoracic aortic aneurysm


How to cite this article:
Hazra D, Fernandes JP, Lohanathan A, Abhilash KP. Right middle and lower lobe collapse by an ascending thoracic aortic aneurysm. Curr Med Issues 2020;18:62-3

How to cite this URL:
Hazra D, Fernandes JP, Lohanathan A, Abhilash KP. Right middle and lower lobe collapse by an ascending thoracic aortic aneurysm. Curr Med Issues [serial online] 2020 [cited 2020 Jul 6];18:62-3. Available from: http://www.cmijournal.org/text.asp?2020/18/1/62/277519




  Introduction Top


Thoracic aortic aneurysms are relatively uncommon compared to abdominal aortic aneurysms. Aortic aneurysms are commonly associated with atherosclerosis. Aneurysms may be detected incidentally through manifestation of local mass effects or systemic symptoms. Rarely presentation is with acute rupture. Mediastinal masses may mimic aortic aneurysms, therefore CT Angiogram and MR Angiogram are the modalities of choice to image this condition. Most patients with thoracic aortic aneurysms are asymptomatic at the time of diagnosis, because the aneurysms are typically discovered incidentally on imaging studies ordered for other indications. When thoracic aortic aneurysms are large, patients may suffer a local mass effect, such as compression of the trachea or mainstem bronchus (causing cough, dyspnea, wheezing, or recurrent pneumonitis), compression of the esophagus (causing dysphagia), or compression of the recurrent laryngeal nerve (causing hoarseness). Surgery is offered when the risk of rupture is greater than the risk of the operation.


  Case Report Top


A 60-year-old male patient presented to the Emergency Department of Christian Medical College, Vellore, with a history of right-sided pleuritic chest pain for 1 month and progressively worsening breathlessness for 3 days. His chest radiograph [Figure 1] was suggestive of right middle and lower lobe collapse with a left pleural effusion. The initial differential was a mass lesion due to a malignancy or lymph node enlargement causing collapse.
Figure 1: Chest radiograph

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A computed tomographic scan of the chest [Figure 2] revealed a 12.5 cm × 12.3 cm partially thrombosed fusiform aneurysm arising from the ascending aorta causing mass effect on the right main bronchus with features of an impending rupture. The patient was diagnosed as a Stanford A type[1],[2] of ascending thoracic aortic aneurysm (TAA), for which he was advised surgery. The patient was not willing to undergo surgery. He was initiated on beta-blockers with an angiotensin receptor antagonist to target a systolic blood pressure between 110 and 120 mmHg. He was followed up 1 month later in the medicine outpatient department with no new complaints. Thereafter, the patient was lost to follow-up.
Figure 2: Computed tomography thorax

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  Discussion Top


The incidence of TAA is estimated to be 5.9–10.4 per 100,000 person-years.[1] Knowledge of the risk factors, pathophysiology, and natural history of aortic aneurysm (AA) is important in clinical decision-making. AAs are classified into TAA, abdominal AA, and thoracoabdominal AA depending on the location. TAA represents approximately one-third of AA admissions, with the remaining cases related to abdominal aortic disease.[2],[3] TAAs are usually asymptomatic unless any complication occurs (e.g., dissection, rupture) or an imaging study has been performed demonstrating the aneurysm. Complications of TAA, such as thoracic aortic dissection, may initially be attributed to another cause; thus, a high index of suspicion must be maintained in patients who present with chest pain. Ascending TAAs may be detected incidentally on a chest radiograph, that may have been done for other indications.[4] When these patients become symptomatic, it is either due to a rupture, dissection, or compression by the aneurysm. Chest radiograph findings commonly documented in literature are widening of the mediastinum, left pleural effusion (due to rupture of the aneurysm), and cardiomegaly. The compression of the left main bronchus in TAA although uncommon has been reported in literature, especially in trauma cases. The compression of the right main bronchus due to an aneurysm, though anatomically possible, to our knowledge, has not been previously reported in literature.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Elefteriades JA, Barrett PW, Kopf GS. Litigation in nontraumatic aortic diseases – A tempest in the malpractice maelstrom. Cardiology 2008;109:263-72.  Back to cited text no. 1
    
2.
Coady MA, Davies RR, Roberts M, Goldstein LJ, Rogalski MJ, Rizzo JA, et al. Familial patterns of thoracic aortic aneurysms. Arch Surg 1999;134:361-7.  Back to cited text no. 2
    
3.
Nathan DP, Xu C, Pouch AM, Chandran KB, Desjardins B, Gorman JH 3rd, et al. Increased wall stress of saccular versus fusiform aneurysms of the descending thoracic aorta. Ann Vasc Surg 2011;25:1129-37.  Back to cited text no. 3
    
4.
Rylski B, Desjardins B, Moser W, Bavaria JE, Milewski RK. Gender-related changes in aortic geometry throughout life. Eur J Cardiothorac Surg 2014;45:805-11.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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