Rapidly Progressive Ascending Aortic Aneurysm Associated With Suspected Giant Cell Arteritis: An Urgent Cardiac Surgical Case

Giant cell arteritis (GCA) may involve the thoracic aorta and cause life-threatening vascular complications.We report an 80-year-old man with polymyalgia rheumatica (PMR) who developed palpitations, dizziness, and intermittent dyspnea.Contrast-enhanced computed tomography (CECT) angiography showed an ascending aortic aneurysm measuring up to 78 mm, compared with an approximately 40 mm diameter on a non-contrast chest CT one year earlier, along with focal aortic wall ulceration.Urgent ascending aortic replacement was undertaken using a 32 mm Dacron graft.Inflammatory changes rendered dissection of the aneurysmal segment technically challenging.Histopathology demonstrated lymphocytic aortitis involving the intima, media, and adventitia, raising suspicion of GCA-associated aortic disease.Postoperative hemorrhage required re-exploration on day one, and atrial fibrillation was treated medically.The patient was discharged on postoperative day seven.Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) at 47 days showed no metabolic evidence of active large-vessel vasculitis.Rheumatologic review at approximately eight months documented clinical remission of PMR under methotrexate and hydrocortisone.This case highlights urgent surgical management of a rapidly enlarging ascending aortic aneurysm and the diagnostic value of histopathological examination of resected aortic tissue.