Utility of contrast-enhanced echocardiography in the diagnosis
and follow-up of a pseudoaneurysm of the aortic arch
Yu Wu1,*, MD,
PhD, Yuman Li1,*, MD, PhD,Jia
Xu1,*, Menghe Wang2, MM, and Qing
Lv1, MD, PhD
1 Department of Ultrasound, Union Hospital, Tongji Medical College,
Huazhong
University of Science and Technology, Wuhan, 430022, China.
2 The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
450000, China
*Contributed equally
Corresponding author:
Qing Lv, MD, PhD.
Tel: 86-27-85726430; Fax: 86-27-85726386.
E-mail address: lvqing1987@hust.edu.cn
Department of Ultrasound, Union Hospital, Tongji Medical College,
Huazhong
University of Science and Technology, 1277 jiefang avenue, Wuhan,
430022, China
A 47-year-old female presented to our hospital with hoarseness for two
years. She had no history of surgery, trauma, hypertension, collagen
disease or other potential infectious diseases. Transthoracic
echocardiography revealed a mass adjacent to the lesser curvature of
aortic arch (Figure 1A). Color flow Doppler imaging did not clearly show
if the mass communicated with the aortic arch. Subsequently,
two-dimensional and three-dimensional contrast-enhanced echocardiography
clearly demonstrated that a large pseudoaneurysm (5.5×6.5 cm)
communicated with the aortic arch via an 8-mm wide defect located on the
opposite side of the left subclavian artery (Figures 1B and 1C, Videos 1
and 2). A thrombus within the pseudoaneurysm cavity was also observed.
Computed tomography (CT) confirmed the diagnosis of pseudoaneurysm of
the aortic arch (Figure 1D). The patient underwent a successful
pseudoaneurysm resection and the aorta replacement. Postoperative
two-dimensional and three-dimensional contrast-enhanced echocardiography
showed no leakage around the vascular graft (Figures 1E and 1F, videos 3
and 4). 23 months later, follow-up two-dimensional echocardiography and
contrast-enhanced echocardiography showed a recurrent pseudoaneurysm
(3.0×1.7 cm) arising from the proximal part of descending aorta (Figures
2A and B, video 5). CT angiography revealed the recurrent pseudoaneurysm
originating from the proximal end of descending aorta (Figure 2C).
Unfortunately, the patient declined any form of treatment. At the
half-month follow-up, the patient died of a ruptured pseudoaneurysm.
Spontaneous pseudoaneurysm of the aortic arch is an exceptionally rare
and potentially life-threatening condition. Diagnosis of pseudoaneurysms
of the aortic arch mainly depends on imaging examinations.
Contrast-enhanced echocardiography, as a non-invasive, bed-side and
radiation-free tool, can greatly improve visualization of the
pseudoaneurysm [1].
In
this case, the extension, neck and mural thrombus of the pseudoaneurysm
are well visualized after contrast administration. Our case highlights
the value of contrast-enhanced echocardiography in the rapid diagnosis
and postoperative follow-up of pseudoaneurysms of the aortic arch.
Informed
consent: Written informed consent was given by the patient’s relatives.
References
1. Sehmi JS, West C, Khattar R, Senior R, Chahal NS. Mass confusion:
defining aortic pathology with ultrasound contrast. Circulation 2015;
132: 1433-1434.
Figure legend:
Figure
1.
Preoperative and postoperative imaging. (a) Echocardiography showing a
mass (asterisk) adjacent to the lesser curvature of aortic arch. (b-c)
Two-dimensional and three-dimensional contrast-enhanced echocardiography
displaying a pseudoaneurysm communicating with the aortic arch (arrow).
(d) CT angiography confirming the presence of pseudoaneurysm of the
aortic arch. (e-f) Postoperative two-dimensional and three-dimensional
contrast-enhanced demonstrating no leakage around the vascular graft.
AAO: Ascending aorta; DAO: Descending aorta.
Figure 2. Follow-up imaging (23 months after surgery). (a)
Echocardiography revealing a recurrent pseudoaneurysm (asterisk) arising
from the proximal part of the descending aorta. (b) Contrast-enhanced
echocardiography demonstrating a recurrent pseudoaneurysm of the
descending aorta. (c) CT angiography reconstruction indicating the
recurrent pseudoaneurysm originating from the proximal descending aorta.
Video
legend:
Video 1: Preoperative two-dimensional contrast-enhanced echocardiography
displaying a pseudoaneurysm communicating with the aortic arch.
Video 2: Preoperative three-dimensional contrast-enhanced
echocardiography revealing a pseudoaneurysm communicating with the
aortic arch.
Video 3: Postoperative two-dimensional contrast-enhanced demonstrating
no leakage around the vascular graft.
Video 4: Postoperative three-dimensional contrast-enhanced showing no
leakage around the vascular graft.
Video 5: Follow-up contrast-enhanced echocardiography demonstrating a
recurrent pseudoaneurysm of the descending aorta.