A Time Bomb in Thorax: Giant Aortic Arch Aneurysm

A 63-year-old Chinese man was referred to our institution with complaints of intermittent cough, hoarseness and dyspnea for more than 1 week. He visited 2 community clinics and received irregular antibiotic therapy, but the symptoms aggravated gradually. He had no history of hypertension. On examination, his heart rate was 108 beats per minute, blood pressure was 112/80 mm Hg, his respiratory rate was 22 breaths per minute and O2 saturation was 96% on room air. Coarse breath sounds were heard on the left. The upper mediastinum was observed to be dilated on chest x-ray (Figure 1A). An emergency computed tomographic angiography scan with 3-dimensional reconstructions showed a giant aneurysm of the aortic arch with the dimensions of 103 mm 3 92 mm 3 95 mm (transverse 3 anteroposterior 3 craniocaudal) with extensive intraluminal thrombus (Figure 1B). The trachea was seen to be markedly compressed by the aneurysm, with narrowing of the distal lumen. The ascending aorta and descending aorta both had normal diameter. The patient was transferred to the intensive care unit for surgical evaluation, and repair of the aortic arch aneurysm was advised, but the patient died suddenly of the ruptured aortic aneurysm before emergency surgery. In summary, our case highlights the unpredictable clinical presentation of a potentially life condition, giant aortic aneurysm. Our case is one of the biggest aortic arch aneurysms mentioned in the literature.