Diagnosis and repair of adult ductal aneurysm

摘要

A 49-year-old Asian man presented to a primary-care physician with vague neurologic symptoms including unilateral left anhidrosis. Workup included a chest computed tomography scan, which revealed a 2.7 x 2.6 x 1.8-cm saccular aneurysm arising from the undersurface of the aortic arch in the region of the ligamentum arteriosum (Fig 1). A small jet of contrast medium from the aneurysm sac into the main pulmonary artery confirmed the diagnosis of ductus arteriosus aneurysm with small left-to-right shunt (Fig 2, arrow). Endovascular repair of the aneurysm was performed with the use of a custom-made covered stent-graft. Follow-up imaging performed 11 months later showed near-complete resolution of the aneurysm sac, with subtle enhancement beyond the margins of! the aorta on axial images (Fig 3). On reconstructed images, this was related to residual filling of the aneurysm sac (Fig 4).