Unusual cause of aortic aneurysm

Clinical introduction

A man in his 40s presented with 3 weeks of chest pain and dyspnoea. Vital signs and cardiopulmonary examination were normal. Serial troponin tests were undetectable. Erythrocyte sedimentation rate (18 mm/hour) and C reactive protein (10.3 mg/dL) were mildly elevated. Blood cultures showed no growth. An ECG showed no ischaemic changes. A transthoracic echocardiogram showed normal right and left ventricular systolic function, no pericardial effusion and an ascending aortic aneurysm. A chest CT angiogram revealed a 5.4 cm ascending aortic aneurysm extending into the aortic arch with sparing of the sinuses of Valsalva ( shows a 3D volume-rendered CT reconstruction of the patient’s aortic aneurysm and an incidental finding of anomalous aortic origin of the left coronary artery from the right sinus of Valsalva). He was referred for urgent surgical repair of his symptomatic aortic aneurysm.


Based on the histopathology of the aortic specimens (figure…

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