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Ann Thorac Surg 2001;71:1043
© 2001 The Society of Thoracic Surgeons

Images in cardiothoracic surgery

Vanishing pulsatile mass on the anterior chest wall

Akira Shimamoto, MD, PhDa, Tsuyoshi Namatame, MDb, Motoshi Takao, MD, PhDa, Hideto Shimpo, MD, PhDa, Isao Yada, MD, PhDa

a Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan
b Department of Internal Medicine, Toyama Hospital, Tsu, Japan

Address reprint requests to Dr Shimamoto, Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507, Japan
e-mail: jj6jdv{at}clin.medic.mie-u.ac.jp

An 84-year-old woman was referred to our department with a thoracic ascending aortic aneurysm. On physical examination, a pulsatile hand-sized mass with a suppurative skin ulcer was palpated in the right anterior chest wall. Computed tomographic scan showed aortic dissection of the ascending aorta with a large amount of thrombus penetrating into the subcutaneous tissue through the fifth intercostal space (Fig 1). However, magnetic resonance angiography revealed a pseudoaneurysm on the ascending aorta, which had mimicked an aortic dissection on the computed tomographic scan. As she had a past history of a syphilitic infection, we suspected a syphilitic aortic aneurysm [1]. Finally, we decided to follow her without surgery.



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  		Fig 1.
 
Three months later, the mass vanished on the chest wall completely without any medication (Fig 2).



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  		Fig 2.
 
References

  1. Heggtveit H.A. Syphilitic aortitis: a clinicopathologic autopsy study of 100 cases, 1950 to 1960. Circulation 1964;29:346-355.[Abstract/Free Full Text]




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