Intercostal artery aneurysm postcoarctation repair diagnosed by magnetic resonance angiography.

A 69-year-old man was referred for investigation of a right upper chest mass. In 1965 he had an aortic coarctation resected with Dacron graft insertion. He remained asymptomatic for the intervening 33 years before presenting with breathlessness on exertion. A chest x-ray showed a right upper lobe mass, and computed tomography showed a descending aorta aneurysm. Cardiovascular magnetic resonance (CMR) imaging, however, demonstrated a huge intercostal artery aneurysm (height 13cm X width 8 cm X depth 12 cm; Fig. l).Gradientecho cine imaging identified significant afferent blood flow, and a central core of thrombus and digital subtraction angiography with three-dimensional reconstruction was performed to identify the origin of the vessel. The short proximal segment arose from the descending aorta, distal to the site of coarctation (Fig. 2). Of interest, the operation note in 1965 recorded a 15-mm aneurysm in the first intercostal artery distal to the coarctation segment, though this was resected along with the coarctation segment. The occurrence of intercostal artery aneurysms in association with aortic coarctation was noted by Cleland et al. in 1956 (l), who expressed surprise at the lack of any reported rupture of these, given the size of the vessel. It was not until 1991 that such a report was published (2). There have been few reports of intercostal artery aneu-