Giant thoracoabdominal aortic aneurysm

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Aneurysms of the descending thoracic and thoracoabdominal aorta are life-threatening conditions with a risk of rupture in the absence of treatment, ranging between 46 and 74%, with a 5-year survival rate of 9–13%1 and a median diameter of the aneurysms at the time of rupture of 7.2 cm.2 In light of this, all aneurysms which have not yet shown an indication for the treatment need regular follow-up to prevent rupture or dissection. The present case concerns an 83-year-old woman with a negative family history for aortic disease, who was referred to our department because of an episode of hemoptysis. She had a 2-year history of 9 cm of thoracic and thoracoabdominal aortic aneurysm, which had already been denied for surgical and endovascular treatment because of the anatomical features of the aneurysm itself and the age of the patient. During the time, the patient was asymptomatic with well controlled blood pressure at home. Because of the hemoptysis episode, the patient had repeated full body angiocomputed tomographic scans which showed an increase in the size of the aneurysm (arrows) with a maximum diameter of 14 cm at the thoracoabdominal tract with a marked dislocation and compression of the surrounding organs and no signs of impending rupture (Fig. 1a–c). The transthoracic echocardiogram control showed a suboptimal visualization because of the marked dislocation of the heart by the huge aneurysm, with no valvulopathies and a hyperkinetic left ventricle with 80% of ejection fraction. Owing to the anatomy of the aorta with the absence of peripheral access (Fig. 2) and the advanced age of the patient, after discussion with the patient's family, the contraindication to surgery and to endovascular treatment was confirmed. She remained well at follow-up visits during the following 7 days, and then she was transferred to a peripheral hospital. Predischarged chest X-ray confirmed the marked enlargement of the thoracic aorta with an acceptable lung pattern (Fig. 3).

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