Thoracic aortic pseudoaneurysm mimicking recurrence of lung cancer

Abstract

A man in his late 70’s visited to a hospital with one day history of fever and cough. Eight years before, he underwent a left upper lobectomy due to stage IB lung cancer. He had taken follow-up Computed Tomography (CT) exams annually and no abnormality was detected 9 months earlier (Figure 1A and B). Laboratory data showed elevated C-reactive protein, 9.7 mg/dL and D-dimer, 2.5 μg/mL with normal white blood cell counts. A chest CT on a visit showed a mediastinal mass near the resected site of left upper lobe (Figure 1C and D) with slight ground- glass opacity around it. Local recurrence of lung cancer with mild pneumonia was suspected, then an oral antibiotic was administered. His fever was alleviated and contrast-enhanced CT was performed one week later for detailed examination, which revealed a ruptured pseudoaneurysm of thoracic aorta (Figure 2A and B). Semi-urgent total arch replacement was completely achieved although it was tough due to severe adhesion of surrounding tissue. He was discharged without any complications on the 30th postoperative day.