LAUSR

A 74-year-old male with known arterial hypertension, treated with amlodipine five milligrams daily, was diagnosed with a T3N2bM2 colon adenocarcinoma. As part of the necessary staging examinations, a thoracic computerised tomography (CT) scan was performed, which incidentally revealed the existence of a giant saccular ascending aortic pseudoaneurysm (106 120 115mm) without involvement of the aortic root and with a normal functioning tricuspid aortic valve on additional transesophageal echocardiography (Figure 1). There was clear evidence for intraluminal thrombotic material (asterisk on Figure 1). Except for a minor degree of exertional dyspnoea, the patient was largely asymptomatic. There was no evidence of an infectious cause, nor there was a history of cardiothoracic surgery or a traumatic event. Therefore, the cause of the pseudoaneurysm remained unclear and was assumed to be spontaneous. The patient ultimately underwent valve sparing aortic root replacement (Gelweave TM, Terumo Aortic, Bolton Medical Inc., USA). Further follow up was uneventful. Aortic pseudoaneurysms result from transmural disruption of the aortic wall, in which luminal blood is held by a thin rim of the remaining adventitia or surrounding structures. They typically occur from focal aortic transection, caused by penetrating or blunt trauma, although infectious and non-infectious causes (e.g. aortitis) have been described as well. Spontaneous pseudoaneurysms are very rare and only few case reports are published. In the presented case the diagnosis was made by chance during routine CTscan and no apparent cause was identified.