"Undiagnosed aortic coarctation with 2 simultaneous acute aortic syndromes: Intramural hematoma and mycotic aneurysm"

Abstract

Acute aortic syndrome can be a fatal pathology if not diagnosed and managed early. Although acute aortic syndrome is more often a diagnosis of adulthood, it may occasionally afflict the pediatric patients. We herein present a case of a 5-year-old female that was discovered to have multiple acute and congenital aortic abnormalities after presenting to the emergency department with infectious symptoms and lower extremity pain. Acute aortic syndrome may not be a top differential consideration in children with acute chest pain; however, it is important to consider because delayed diagnosis and management can have fatal implications.

Keywords: Aortic coarctation; Computed tomography angiography; Intramural hematoma; Mycotic aneurysm.

Fig. 1

Non-cardiac gated contrast enhanced computed tomography angiogram of the aorta. (A) Sagittal oblique multiplanar reconstruction image of the thoracic aorta (candy cane view) demonstrating the post-ductal location of the aortic coarctation (chevron), as well as the intraluminal aortic thrombus (arrowhead). (B) Coronal MPR of the thoracic aorta demonstrates the aortic saccular outpouching along the left aspect of the proximal descending thoracic aortic segment (arrow) and adjacent aortic intraluminal thrombus (arrowhead). (C) Axial image of the mid-descending thoracic aorta demonstrating the aortic intraluminal thrombus (arrowhead), as well as mild volume pleural effusions (small arrows) and dependent lower lobe atelectasis (stars).

Fig. 2

Three-dimensional volume rendered reconstruction of the aorta as viewed from the patient's left (A) and right (B) demonstrating the post-ductal location of the aortic coarctation (chevron), as well as the aortic saccular outpouching along the left aspect of the proximal descending thoracic aortic segment (arrow).