An Elongated Oval-Shaped Echolucent Structure Centered in the Transverse Aortic Arch: Evidence of a Vascular Disaster or a Lucky Break?

Abstract

A PLEASANT, VERY COOPERATIVE, 58-year-old, 160-cm, 79-kg woman presented to the authors' institution for evaluation of acute, severe chest pain radiating to her back. She was otherwise asymptomatic. The patient had a past medical history of well-controlled essential hypertension and tobacco abuse but had been previously healthy and denied a history of cardiovascular disease. The patient was initially treated with intravenous morphine and esmolol while further work-up was conducted. The physical examination was completely unremarkable; heart sounds were normal without murmur, the lungs were clear to auscultation, the peripheral pulses were strong and equal in all 4 extremities, and no focal neurologic deficits were observed. A chest radiograph was obtained and transesophageal echocardiography was performed as part of the evaluation (Fig 1, Fig 2, respectively). What is the diagnosis? Why was the patient neurologically intact? Fig 2A 2-dimensional TEE image of the transverse aortic arch showing the presence of an elongated oval-shaped echolucent structure. View Large Image Figure Viewer Download Hi-res image