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).