Aneurysm of the thoracic aorta complicating pseudo-coarctation.

Introduction: the aneurism of the descending aorta complicating a pseudocoa rctation, itself due to a congenital elongation with kinking of the aorta i s a rare entity. Observation: we report a case of aortic aneurism discovered in a 72 years o ld woman without notable antecedents, which was referred for recurrent bron chitis. The X-ray showed a calcified opacity of the upper mediastinum. 5 cm of large. A thoracic CT-scan evoked the presence of a circulating saccifor m aneurism with calcified walls, developing on the final part of the aortic arch, which was with abnormally ascending way going up to the cervico-thor acic orifice and carrying out an aspect of aortic kinking. The assessment was complemented by a RMI as well as an aortic opacification . A thoracic scintigraphy showed an hypoperfusion of the left lung. The rem ainder of the cardiac assessment was normal. The patient was operated under femoro-femoral extracorporeal circulation th rough a left posterolateral thoracotomy of the 4th intercostal space. The e xamination showed a 7 cm diameter calcified aneurysm of the descending thor acic aorta complicating a tight stenosis in connection with an elongation a nd a kinking. The upper section of the aorta was shifted towards the pleural dome. The ao rtic section above aneurism was of normal size whereas the lower section wa s dilated. The aneurism was excised and a prosthetic graft was carried out. The surgery follow-up was marked by an hemodynamic stability, without neuro logical deficit. A ventilatory assistance was necessary during 5 days. Curr ently with 8 months follow-up, the patient goes well. Comments: a prosthetic replacement in front of this type of aneurism is leg itimate given the risk of the occurrence of complications secondary to the pseudocoarctation (arterial hypertension, aortic insufficiency) or to the a neurism itself, dissection or compression of vicinity (pulmonary artery).