An Ascending Aortic Rent with a Saccular Aneurysm: Role of Multimodality Imaging

We report an unusual case of 26 year old previously healthy man who presented with exertional breathlessness of 6 months duration with clinical findings suggestive of moderate aortic regurgitation (AR). There was no previous history suggestive of trauma or chest pain. Trans-thoracic and trans-esophageal echocardiography showed an ascending aortic aneurysm compressing the Left atrium and presence of moderate AR. A 64 slice cardiac CT with intraaortic endoscopic reconstruction further clarified the anatomy. This revealed an ascending aortic aneurysm, extending into the middle mediastinum with a clear rent in the ascending aorta, communicating with the aneurysm. More importantly, CT imaging also confirmed the absence of a dissection flap. The case demonstrates the usefulness of multimodality imaging in defining the morpho-anatomic features in such unusual situations.