A silent trio: Giant descending aortic aneurysm combined wit
Authors report a case of an undiagnosed descending aortic aneurysm, combined with coarctation and persistent left brachiocephalic truncus in a 59-year-old male. It highlights the necessity for aortic imaging, when facing a poorly controlled hypertension.

A 59-year-old Albanian man presented 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 mm Hg, with a heart rate of 110 beats per minute. A diastolic murmur was the only finding in the auscultation, and an electrocardiogram was considered within normality. A CT angiogram of the thorax was performed the same day, with images of a coarcted portion whose diameter was less than 7 millimeters in the axial image, followed from a dilated, giant descending aortic aneurysm that reached a maximum of 9.8 cm in transverse diameter.

A dissecting flap of more than four centimeters in length was well visualized. Hypertrophic intercostal arteries were present at the sagittal reconstructed CT images. The coarctation neck was visible in the sagittal reconstructed contrast-enhanced CT images. The patient was never diagnosed previously for coarctation; furthermore, the axial CT images showed the presence of left brachiocephalic artery.

Source: https://onlinelibrary.wiley.com/doi/10.1002/ccr3.4721?af=R
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