Multimodal visualization of a retrocardial bronchial artery aneurysm with rare origin from the distal descending aorta

Abstract

An 89-year-old woman in good clinical condition was admitted with intermittent thoracic pain and chronic hypertension. Clinical examination and laboratory tests revealed no significant results. Because of a suspicious retrocardial mass on the routine chest radiograph, a contrast-enhanced cardiac MR examination (1.5 T) was conducted. The MR images displayed a vascular structure between the right atrium and the spine with a diameter of three centimeter and eccentric thrombosis (Fig. 1a). The perfused lumen was 1-cm-wide. A vascular connection between the descending aorta into the aneurysm was detected by MR angiography (Fig. 1b). We, therefore, raised the diagnosis of a bronchial artery aneurysm with an atypical origin from the distal descending aorta, whereas almost all hitherto described aneurysms originate from the aortic arch or the proximal descending aorta [1–3]. The contrast-enhanced multislice CT-scan confirmed the diagnosis of a retrocardial bronchial artery aneurysm originating from the distal descending aorta with arteriosclerosic calcifications. The complete course of the bronchial artery through the aneurysm into the pulmonary parenchyma was displayed by the curved reformation (Fig. 2). There were no signs of active bleeding or perforation. In addition, pulmonary indurations were diagnosed in the basal right lung, probably as residuum of recurrent pulmonary infections. To prevent the future rupture of the aneurysm and secondary complications, we recommended a percutaneous