Abstract Introduction The incidence of thoracic aortic aneurysm (TAA) is approximately 5-10 per 100,000 patient-years, with descending TAA accounting for 30% of all TAAs. Descending TAAs mostly remain asymptomatic, however, may present with chest or back pain. They may also be accompanied by hemodynamic instability or compressive symptoms. Here, we report a rare manifestation of Descending TAA in an elderly female who presented with a chest wall swelling secondary to a contained rupture. Case Presentation An 82-year-old female with a past medical history of tobacco abuse, hypertension, atrial flutter, chronic renal insufficiency, hypercholesterolemia, and GERD presented to an outside hospital with complaints of thoracic back pain and swelling in upper lateral chest wall swelling since one month. She denied palpitations, light headedness, cough, hemoptysis, shortness of breath or previous diagnosis of cancer. The swelling was warm and pulsatile on palpation with no overt bleeding. CT chest/abdomen/pelvis with contrast revealed 8 cm Descending TAA protruding through the lateral chest wall, suggesting a contained rupture. She was referred to our center for further management. On presentation, she was hemodynamically stable and afebrile. Labs were significant for leukocytosis of 17.6 and anemia with hemoglobin of 7.5. She was found to have a fungal infection in her groin. She received 2 units of blood transfusion, antibiotics, and topical antifungal. The case was discussed with a multidisciplinary committee , who decided to proceed with thoracic endovascular aortic repair (TEVAR) given the patient’s advanced age and multiple comorbidities. TEVAR was performed after resolution of the fungal infection to avoid post operative infective complications. The patient convalesced well and was eventually discharged home. She was asked to follow up for periodic monitoring with CT Angiography. Discussion Descending TAA is a rare but life-threatening condition requiring emergent treatment. Patients are usually asymptomatic but can present with compressive symptoms or acute complications. Our case highlights an unusual clinical presentation of Descending TAA manifesting as progressive chest wall swelling. This could be confused for a soft tissue infection or neoplasm leading to delay in diagnosis with possibly fatal consequences . CT aortogram remains a diagnostic modality of choice. Existing evidence strongly supports TEVAR in older individuals with multiple comorbidities due to lower perioperative mortality and morbidity, fewer neurological complications, and shorter ICU and hospital stays, making TEVAR a standard treatment in high-risk patients compared to open repair. This abstract is funded by: none
Liaqat et al. (Fri,) studied this question.