Inflammatory Aneurysm of the Ascending Aorta
Dissection Ante Portas?
A 72-year-old woman with a medical history of hypertension and non–insulin-dependent diabetes mellitus was admitted to our hospital with progressively deteriorating chest pain. Coronary angiography demonstrated significant disease in the left anterior descending and proximal circumflex arteries. Contrast-enhanced computed tomography of the thoracic aorta revealed an ascending aorta aneurysm with a maximal diameter of 5.3 cm and a thick wall (Figure 1). At surgery, the ascending aorta appeared white, glistening, and edematous (peau d’ orange) with circumferential thickening, suggesting an inflammatory process (Figure 2). The patient underwent an ascending aorta and hemiarch replacement with a tubular graft combined with double CABG. During surgical manipulation, we verified a remarkable tendency of the aortic wall toward dissection. The procedure was well tolerated, and recovery was uneventful. Histological examination of the resected specimen revealed a markedly thickened tunica adventitia and an edematous tunica media with signs of dissection between these 2 layers (Figure 3). In addition, there was infiltration with lymphocytes and plasma cells (Figure 4).
Inflammatory aneurysms of ascending aorta are extremely rare, and the diagnosis is very difficult preoperatively.1–3 In our patient, the macroscopic and microscopic findings were highly suggestive of an impending “catastrophic” aortic dissection. This raises the question of whether this fragile inflammatory condition requires surgery at earlier stages than other aneurysms of the ascending aorta.