Katie GilesBenjamin HibbertMunir BoodhwaniMichel R. Le May

A pulsatile chest wall mass: pseudoaneurysmof the ascending aorta

Received: 30 November 2013Accepted: 4 January 2014

� Springer-Verlag Berlin Heidelberg and ESICM 2014

K. Giles � B. Hibbert � M. R. Le May ())Division of Cardiology, University of Ottawa Heart Institute,40 Ruskin Street, Ottawa, ON K1Y 4W7, Canadae-mail: MLeMay@ottawaheart.caTel.: ?1-613-7614223Fax: ?1-613-7614690

M. BoodhwaniDivision of Cardiac Surgery, University of Ottawa Heart Institute,Ottawa, ON, Canada

A 78-year-old female was emergently transferred to ourtertiary cardiac intensive care unit with a decreased level

of consciousness, shock, and a new, pulsatile, 8 9 8-cmmass of the left anterior chest wall (Fig. 1). A continuousto-and-fro murmur was audible over the mass. She had ahistory of lung cancer treated 7 years earlier with resec-tion of the left upper lobe and chest wall, which wasreconstructed with a Gore-Tex graft.

Bedside focused cardiac ultrasound revealed an echo-lucent, pulsatile mass (Fig. 2, asterisk). Computedtomography demonstrated a fistulous communicationbetween the aorta and a pseudoaneurysm anterior to the

Fig. 1 Physical examination revealed a pulsatile, 8 9 8-cm massof the left anterior chest wall

Fig. 2 Point-of-care focused cardiac ultrasound images demon-strated a pulsatile echolucent mass (asterisk)

Intensive Care MedDOI 10.1007/s00134-014-3211-1 IMAGING IN INTENSIVE CARE MEDICINE

Gore-Tex graft into the left chest wall (Fig. 3, blackarrow).

Due to multiple comorbidities and the high-risk natureof intervention, the family opted for palliation, and thepatient passed away in the cardiac intensive care unit.

Conflicts of interest On behalf of all authors, the correspondingauthor states that there is no conflict of interest.

Ethical standard According to ethical practices, consent wasobtained for use of information and images, and the patient’sidentity has been kept confidential.

Fig. 3 Computed tomographystudies of the thorax. a Afistulous communication (blackarrow) with bidirectional flowinto the pseudoaneurysm isshown. b Three-dimensionalreconstruction demonstrates theprotrusion of the aneurysm fromthe chest wall