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Heart, Lung and Circulation
Image| Volume 32, ISSUE 3, e16-e18, March 2023

Iatrogenic Aortic Pseudoaneurysm Causing Superior Vena Cava Syndrome

Published:December 24, 2022DOI:https://doi.org/10.1016/j.hlc.2022.11.011
      A 72-year-old man presented with a 5-week history of exertional dyspnoea and facial swelling on a background of hypertension and previous coronary artery bypass graft (CABG) surgery for acute coronary syndrome (left internal mammary artery to left anterior descending/third diagonal branch and left radial artery to first obtuse marginal) 5 years prior. He denied any facial pain, headache or arm swelling. He was lost to follow-up following his coronary artery bypass graft (CABG) surgery. On clinical examination, the heart rate was 70 bpm and blood pressure was 160/90 mmHg. The patient was noted to be plethoric, with facial swelling and distended external jugular veins (Figure 1A). Carotid pulse was of normal character and without bruits. His heart sounds were dual with no added sounds or murmurs. Auscultation of his lungs did not reveal any abnormalities and there was no peripheral oedema.
      Figure thumbnail gr1
      Figure 1(A) Distended external jugular vein. (B) Chest X-ray demonstrating a widened mediastinum. (C) Transthoracic echocardiogram demonstrating a dilated ascending aorta measuring 8.1 cm. (D) Sagittal view of the aorta revealing a pseudoaneurysm compressing the superior vena cava (green arrows). (E) Multiplanar reconstruction showing the aortic dissection (yellow arrows). (F&G) 3-dimensional multiplanar computed tomography reconstruction demonstrating circumferential aortic dissection extending from the proximal ascending aorta to aortic arch (blue arrows).

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