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Asian Cardiovasc Thorac Ann 2008;16:88-89
© 2008 Asia Publishing EXchange Ltd

IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY

Hemoptysis Due to Aortic Aneurysm at the Site of Coarctation Repair

Ahmad A Amirghofran, MD, Reza Mollazadeh, MD1, Javad Kojuri, MD1

Cardiac Surgery Department
1 Cardiology Department, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran

For reprint information contact: Reza Mollazadeh, MD, Tel: 98 917 313 3749, Fax: 98 711 6261089, Email: mollazar{at}yahoo.com, Cardiology Department, Nemazee Hospital, Zand Avenue, Shiraz, Iran.

A 30-year-old man with Dacron graft aortoplasty for aortic coarctation 20 years earlier, was admitted with massive hemoptysis. Chest radiography indicated a normal cardiac silhouette with mediastinal widening due to a mass lesion in the aorta. Fiberoptic bronchoscopy showed no active bleeding, but the left bronchi were compressed from the outside. Magnetic resonance imaging revealed discrete aortic bulging just after the left subclavian artery branches (Figure 1AGo). Nonselective aortography demonstrated a huge aortic aneurysm without any connection to the pulmonary vascular bed (Figure 1BGo).


Figure 1
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  		Figure 1. (A) Magnetic resonance angiography showing an aortic aneurysm just after the left subclavian artery branches. (B) Aortography showing a huge aortic aneurysm originating from the native aortic wall (thick black lines), not the previous repair side (thin black lines), without any connection to the pulmonary vascular bed.

 
At surgery, an aneurysm was found in the native descending aortic wall rather than the previous repair site (Figure 2Go). The aneurysm was resected and a Dacron graft was interposed. The patient recovered uneventfully and was discharged asymptomatic. Hemoptysis was probably due to obliteration of pulmonary microvasculature and pressure necrosis of bronchi.


Figure 2
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  		Figure 2. Huge aortic aneurysm with no pseudoaneurysm or fistula to the pulmonary vascular bed.

 





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