[Lung cancer simulating dissecting aneurysm of the aorta]

The report analyzes a rare case of lung cancer presenting as a dissecting aortic aneurysm. A 59-year-old patient was admitted to the Department of Cardiosurgery of the Institute of Cardiology, Poznań Medical School, with a preliminary diagnosis of dissecting aneurysm of ascending aorta. The patient had hypertension treated for 5 years and 3 year history of retrosternal pains. He had smoked 20 cigarettes daily for 20 years. On admission a strong chest pain radiating into the ++inter-scapular region was reported. After two days the radiation extended into the lumbosacral area. Blood pressure was 180/100 mmHg. After 7 days paresis of the lower extremities occurred. Ecg showed only hypertrophy of the left ventricle. Chest X-ray revealed dilatation of the mediastinum and enlargement of the lungs, without focal changes. Echo (M + 2D + Doppler) suggested aortic wall dissection in the ascending part and the arch. The DSA examination did not reveal the dissection, which in turn suggested mediastinal tumor. TC presented an extensive infiltration of the upper-medial part of the right lung and invaded right mediastinum. The final diagnosis, oat cell carcinoma, was established after the histopathological analysis of a biopsy specimen taken in the course of bronchoscopy. The patient died at home after two months of oncological treatment. Autopsy was not performed. In spite of considerable progress of the diagnostic technics both dissecting aortic aneurysm and lung cancer still present a very difficult clinical problem.