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Ann Thorac Surg 2005;80:1098-1100
© 2005 The Society of Thoracic Surgeons

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Case report

Symptoms Plus Family History Trump Size in Thoracic Aortic Aneurysm

Section of Cardiothoracic Surgery and Cardiovascular Anesthesia, Yale University School of Medicine, New Haven Department of Cardiology, Hartford Hospital, Hartford, Connecticut

Accepted for publication February 18, 2004.

^_* Address reprint requests to Dr Elefteriades, Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT06510; (Email: john.elefteriades{at}yale.edu).

A 43-year-old woman presented with chest pain of unclear cause. The patient’s mother and brother had suffered aortic dissection. Echocardiography had shown mild dilatation of the ascending aorta at 4.0 cm. Echocardiogram and magnetic resonance imaging were negative for dissection. The patient was taken to the operating room on the basis of her painful symptoms and her family history. Unexpectedly, a localized dissection was found in the ascending aorta (see Fig 2), which was too small for imaging detection. Without preemptive surgery, full-fledged dissection would have likely occurred with attendant short and long-term consequences. This case emphasizes that size criteria pertain to asymptomatic patients, and symptomatic patients with aneurysm require resection regardless of size.

View larger version (116K): [in this window] [in a new window]   Fig 2. Gross appearance of radiographically undetected aortic dissection. (Arrow shows localized dissection.)

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