A 76-year-old female presented to primary care physician with a complaint of progressive dyspnea on exertion for three months. She denied chest pain, dizziness or back pain. She had been smoking two packs of cigarette per day for 50 years and had history of gastroesophageal reflux disease. Physical examination revealed decrease breath sounds in left lung field. Cardiac examination was unremarkable. Chest X-ray showed a large mass within the mediastinum and the left hemithorax (Figure 1). A contrast enhanced chest computed tomography scan demonstrated a large thoracoabdominal aortic aneurysm (TAA) measuring 11 cm at its greatest diameter in thorax compressing the left atrium (Figure 2). Circumferential thrombus was surrounding the true lumen but no contrast extravasation or leak was noticed. She was transferred urgently to our facility for further management. After complete preoperative work up repair of the thoracoabdominal aneurysm was planned.

The exact incidence of TAA is unknown but the adjusted incidence of TAA is closer to 2.2 per 100,000 person-year. [1] The 5-year survival of untreated TAA patients ranges from 7–20%. [1] Given this poor prognosis, early diagnosis of this condition becomes extremely important. Contrast-enhanced CT scanning is one of the preferred modalities to diagnose aortic aneurysm, determine its size and delineate the aortic anatomy. [2] The CT scan also provides detail information about the extraluminal structures which helps in planning the surgical intervention.

This case highlights the importance of this quick, readily available and noninvasive imaging technique in the diagnosis and management of TAA.

1. Webb TH, Williams GM. Thoracoabdominal aneurysm repair. Cardiovasc Surg 1999;7(6):573-85.   [CrossRef]   [Pubmed]    
2. Isselbacher EM. Thoracic and abdominal aortic aneurysms. Circulation 2005;111(6):816-28.   [CrossRef]   [Pubmed]