Methodist Journal

IN THIS ISSUE

Venous Interventions

Vol 14, Issue 3 (2018)


FEATURED GUEST EDITOR

ISSUE INTRO

It’s Time We Reassess Our Primitive Understanding of the Venous System

See More
RECOGNITIONS

Jean Bismuth Spearheads Issue on Venous Interventions

See More

REVIEW ARTICLES See More

Central Venous Pathologies: Treatments and Economic Impact

Venous Thrombosis and Post-Thrombotic Syndrome: From Novel Biomarkers to Biology

Mechanical Properties of Diseased Veins

Use of Computed Tomography and Magnetic Resonance Imaging in Central Venous Disease

Application of Intravascular Ultrasound in End-Stage Renal Patients with Central Venous Occlusive Disease

Intraoperative Imaging and Image Fusion for Venous Interventions

Endovascular Treatment for Venous Diseases: Where are the Venous Stents?

Endovascular Therapy for Central Venous Thrombosis

CASE REPORTS See More

Immune Checkpoint Inhibitor Related Cardiotoxicity

Tyrosine Kinase Inhibitor-Induced Acute Myocarditis, Myositis, and Cardiogenic Shock

Primary Nonbacterial Thrombotic Endocarditis Presenting with Bowel Infarction Secondary to Superior Mesenteric Artery Embolism

Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Incision and Drainage of a Forgotten Vascular Graft

CLINICAL PERSPECTIVES See More

EXCERPTA

Telemedicine Shakes Up the ICU Experience

POINTS TO REMEMBER

Venous Thrombosis in Nephrotic Syndrome

EXCERPTA

Heartsick: Medical and Ethical Challenges of Infective Endocarditis in the Opioid Epidemic

EXCERPTA

Redefining “Worth It” for CTO PCI

EDITORIALS

Letter to the Editor

Vol 14, Issue 1 (2018)

Article Full Text

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER

Ruptured Aortic Pseudoaneurysm: An Unusual Cause of Recurrent Lightheadedness and Cough

Jump to:
Article Citation:

DaSilva-DeAbreu A, Moore AE, Arain S. Ruptured Aortic Pseudoaneurysm: An Unusual Cause of Recurrent Lightheadedness and Cough. Methodist DeBakey Cardiovasc J. 2018;14(1):66-67.

doi: 10.14797/mdcj-14-1-66

Keywords
ascending aorta , pseudoaneurysm , mediastinal hematoma , cardiopulmonary bypass

CASE PRESENTATION

A 60-year-old man with end-stage renal disease was referred to the emergency room for hypotension during dialysis. He had a history of hypertension, atrial fibrillation, heart failure with preserved ejection fraction, and recurrent methicillin-sensitive Staphylococcus aureus (MSSA) mitral endocarditis with embolic stroke. He had recently undergone surgical mitral repair complicated by ascending aortic pseudoaneurysm with a surrounding stable hematoma (3.8 x 6.7 x 9.3 cm) (Figure 1), for which he was planning elective surgery.

At the time of presentation, the patient only complained of a several-day history of episodic lightheadedness. He was hypotensive (90/50 mm Hg) and tachycardic (114 beats/min). A computed tomography angiography showed a ruptured pseudoaneurysm with “swirl sign” (Figure 2 A). The hematoma had enlarged (9.6 x 12.2 x 14 cm), compressing the mediastinal vessels and trachea with right ventricular strain (Figure 3). There was active blood flow extravasating into the hematoma (Figure 2). Hemoglobin was at baseline (9.9 g/dL). The patient underwent pseudoaneurysm resection and aortic reconstruction. Cultures of the pseudoaneurysm grew MSSA. He was treated with cefazolin and his symptoms resolved.

Figure 1.
Figure 2.
Figure 3.

Ascending aortic pseudoaneurysms are uncommon but potentially fatal.1,2 Typical findings include intense chest pain and hypotension, and survival depends on early diagnosis and surgery. This case is notable for its atypical, relatively indolent course and low bleeding rate despite the swirl sign. Furthermore, compression of mediastinal structures seems to have been the cause of his unusual symptoms rather than hypovolemia or pain.

This case illustrates how ruptured aortic pseudoaneurysm can present with benign symptoms. Physicians should be highly suspicious when evaluating patients with an atypical constellation of symptoms after cardiothoracic surgery. Timely imaging can help to promptly diagnose the condition and plan interventions.

References

1. Sullivan KL, Steiner RM, Smullens SN, Griska L, Meister SG. Pseudoaneurysm of the ascending aorta following cardiac surgery. Chest.
1988 Jan;93(1):138-43.
2. Razzouk A, Gundry S, Wang N, et al. Pseudoaneurysms of the aorta after cardiac surgery or chest trauma. Am Surg. 1993 Dec;59(12):818-23.

Add Comments

Please login to dialogue with author.

Comments