Case Report:
The patient is a 74-year-old female with a past medical history significant for asthma, hypertension, diabetes, and rheumatoid arthritis on etanercept. She was initially admitted for respiratory failure due to pulmonary edema. She did not present with chest pain on admission. Her echocardiogram was significant for a decreased ejection fraction to 36%, and moderate to severe aortic regurgitation. Computed tomography angiogram (CTA) demonstrated an incidental aneurysmal ascending aorta measuring 5.9 cm in diameter with dissection that did not involve the arch vessels, as well as a small penetrating atherosclerotic ulcer. The patient was taken to the operating room for open repair of her ascending aortic dissection. No blood was encountered when the pericardium was opened. Upon entry, the walls of the dissected aorta were noted to be thickened and densely adherent to the pulmonary trunk and the right pulmonary artery, consistent with an acute-on-chronic aortic dissection. The dissection was limited to the ascending aorta that did not extend proximal to the sinotubular junction. She underwent open repair with a 34mm Gelweave supra-coronary graft and her aortic valve was repaired using a sub-comissural annuloplasty. Postoperative echocardiogram demonstrated near complete resolution of her aortic insufficiency. Her postoperative course was uneventful, and she was discharged home after her stay in rehabilitation. Her pathology was significant for aortitis with poorly formed granuloma, giant cells, and medial necrosis, consistent with giant cell arteritis (Figure 1).