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Cardiovascular Disease |

Hemoptysis: An Unusual Presentation for the Pseudoaneurysm of Aortic Arch

Amareshwar Podugu, MD; Mohamad Adam, MD; Nihad Boutros, MD
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Canton Medical Education Foundation, Canton, OH


Chest. 2013;144(4_MeetingAbstracts):143A. doi:10.1378/chest.1702931
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Abstract

SESSION TITLE: Cardiovascular Student/Resident Case Report Posters I

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Hempotysis is a rare presentation of aortic arch pseudo-aneurysm. We describe a case of aortic arch pseudo-aneurysm (late complication of thoracic aortic arch repair) presenting with an episode of hemoptysis.

CASE PRESENTATION: 74 year-old-male presented with sudden onset 200 ml episode of hemoptysis, which was progressively getting worse with no evidence of fever and chills. He denied any other complaints. His PMH is significant for HTN, hyperlipidemia, tobacco abuse and extensive athero-vascular-sclerotic-disease, only on aspirin. He had CABG and saccular distal aortic arch aneurysm repair, 2 years prior to this presentation. On exam, his vitals were stable with normal findings. His CBC, coagulation panel, chest X-ray were all with in normal limits. Sputum and blood cultures were sterile. Bronchoscopy revealed streaks of blood present along the left bronchi with no evidence of any endo-bronchial lesions. Thoracic CT-Angio showed the presence of multiple aneurysms with the largest pseudo-aneurysm measuring 2.8 cm at the site of previous repair. In the absence of intra-bronchial lesion and with the presence of a pseudo-aneurysm abutting the lung tissue, the likely source of hemoptysis was considered to be the pseudo-aneurysm. He underwent a successful aortic arch pseudo-aneurysm repair with post-op bronchoscopy revealing no bleeding.

DISCUSSION: Thoracic aortic aneurysm is defined as a permanent localized dilation of an artery having at least 50% increase in diameter compared with the expected normal diameter. Unlike true aneurysm, pseudo-aneurysm represents a collection of blood and connective tissue out side the vessel wall. Our case demonstrates pseudo-aneurysm as a late complication of aneurismal repair, manifesting as hemoptysis. Pseudo-aneurysm of the thoracic aorta is a rare condition that usually occurs following blunt trauma. There are several case reports of aortic aneurysms presenting as massive hemoptysis needing emergent treatment with the correction of aorto-bronchial fistula. Our case differs in this regard by presenting without massive hemoptysis (< 600ml). Aortic aneurysms are usually seen in patients with risk factors for atherosclerosis. They are often clinically silent and incidentally diagnosed. They sometimes manifest with unusual symptoms by compressing on the surrounding structures. Treatment includes endoluminal stent graft and/ or open surgical repair.

CONCLUSIONS: Aortic arch pseudo-aneurysms are uncommon cause of hemoptysis. A high index of suspicion and awareness among the clinicians is needed to diagnose aortic pseudo-aneurysm in all patients with unexplained hemoptysis, especially in those patients with previous history of thoracic surgery and chest trauma.

Reference #1: Naha K, et al. BMJ Case Rep. 2013 Feb 13; 2013. doi: 10.1136/bcr-2012-008160.

DISCLOSURE: The following authors have nothing to disclose: Amareshwar Podugu, Mohamad Adam, Nihad Boutros

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