Abstract
Pseudoaneurysm of ascending aorta carries high mortality and morbidity due to adhesions and compression over surrounding structures. It occurs either after some form of injury to aorta or after infectious pathology. Spontaneous pseudoaneuryms are very rare as are the extrinsic compression of left main coronary artery. We are presenting a case with both of these rare ties. Patient was a female of middle age presented with cough and a past history of treated pulmonary tuberculosis 12 years before. During evaluation by X-ray, CECT is a large pseudoaneurysm of ascending aorta with oval defect in posterior wall above sinotubular junction. It was compressing 90% of the left main coronary artery, occluding 100% of the right pulmonary artery with formation of collaterals to it from surrounding arteries. Active tuberculosis and syphilis were ruled out. Patient underwent excision of pseudoaneurysm, replacement of ascending aorta by Dacron graft and coronary artery bypass under TRCA and CPB. There was massive intraoperative bleeding, and patient died on the fourth day due to sepsis and ARDS.
Highlights
Pseudoaneurysm of ascending aorta without any operative procedure on aorta can be due to infective pathology and is known as mycotic aneurysm
Tubercular involvement of aorta can rarely present as pseudoaneurysm
This entity carries very high mortality and morbidity since it is rare and experience is limited in dealing this complex entity compressing important structures like the left main in our case
Summary
Pseudoaneurysm of ascending aorta without any operative procedure on aorta can be due to infective pathology and is known as mycotic aneurysm. As far as tuberculous mycotic pseudoaneurysms of the ascending aorta are concerned, it is extremely rare. Sachin et al have suggested that it is common if suspected in appropriate clinical setting and they have reported 8 cases of tuberculous involvement in various parts of the aorta including one having a pseudoaneurysm of the ascending aorta. This entity carries very high mortality and morbidity since it is rare and experience is limited in dealing this complex entity compressing important structures like the left main in our case
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