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Giant Ascending Aortic Aneurysm With Atypical Presentation as Abdominal Pain

Juan P Moreno Dirzo¹, Fernanda M Castillo Esquivel¹, Liliana A Guatemala Moreno¹

¹Heart Failure Department, Unidad Médica de Alta Especialidad Hospital de Cardiología Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico.

JACC. Case Reports

|August 8, 2026

Abstract

Background:

Ascending aortic aneurysms typically present with chest or back pain; however, atypical presentations may delay diagnosis.

Case Summary:

A 58-year-old woman presented with acute lower abdominal pain and diaphoresis. Hypertension and a new diastolic murmur prompted cardiology evaluation, revealing clinical signs of chronic severe aortic regurgitation. Imaging confirmed a giant ascending aortic aneurysm (89 × 83 mm) with severe aortic regurgitation.

Discussion:

This case emphasizes atypical presentations of thoracic aortic disease, compensated high-risk anatomy, and timely referral to specialized aortic centers to facilitate definitive surgical care despite temporary institutional capacity constraints.

Take-Home Messages:

Giant ascending aortic aneurysms may remain clinically compensated despite high-risk anatomy and present atypically, requiring high clinical suspicion and early multimodality imaging. When definitive repair is delayed by system-level constraints, structured interim stabilization, surveillance, and referral coordination are critical.

Keywords:

aorta aortic regurgitation aortic valve imaging

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