CLINICAL IMAGES
A 59-year-old Albanian man presented at for radiological evaluation following a two -week period of effort dyspnea. He had a poorly controlled hypertension and was a lifetime heavy smoker (more than twenty cigarettes daily). During a cardiological consultancy, his blood pressure was 170/120 mmHg, with a heart rate of 110 beats per minute. A diastolic murmur was the only finding in the auscultation, and electrocardiogram was considered within normality. A CT angiogram of the thorax was performed the same day, with impressive images of a giant descending aortic aneurysm that reached a maximum of 9,8 centimeters in transverse diameter (Figure 1a and 1b).
<Figure 1a-b here>
A dissecting flap of more than four centimeters was as well visualized. Proximally to the dilated portion, the aortic arch was severely coarcted, with a narrowed opening of about 6,8 millimeters in the transverse diameter. Hypertrophic intercostal arteries were present at the sagittal reconstructed CT images. The patient was never diagnosed previously for coarctation; furthermore, the axial CT images showed the presence of left brachiocephalic artery (Figure 2a and 2b).
<Figure 2a-b here>
Giant asymptomatic aortic aneurysms are rarely reported, but still present and therefore, a cause of major concern in emergency medicine [1, 2].