Haemoptysis as a Rare Presentation of Aortic Arch Aneurysm: A Case Analysis

Abstract

Background: Hemoptysis is a very rare but possible complication of Aortic Arch Aneurysm (AAA) and is usually due to an erosion of the aneurysm into the trachea or rupture of the aneurysm into the lungs. Rupture of an aortic aneurysm is a catastrophic event associated with a very high mortality of >30%. Globally the incidence of AAA is 5-10 per 100,000 person-years.  Approximately 15,000 people in the United States and 30,000 in Europe are diagnosed with AAA each year. The disorder is more common in men than in women, with prevalence rates estimated at 1.3– 8.9% in men over the age of 60 years.

Case: This paper presents a 43-year-old male, known hypertensive who presented with acute onset of hemoptysis associated with left sided pleuritic chest pains, cough and sweating for two days. He had a previous history of surgery for repair of coarctation of aorta with recurrent hypertensive crisis episodes. ECG showed normal sinus rhythm with signs of left ventricular hypertrophy (LVH). Echocardiography showed normal biventricular systolic function with an Ejection fraction (EF) of 65%. Chest CT scan was done, revealed a large leaking saccular distal aortic arch aneurysm with hemo-pneumothorax.

Conclusion: Hemoptysis as a symptom of aortic arch aneurysm is a rare yet critical finding that requires prompt evaluation  with a thorough focused history taking and physical examination with associated investigation. ECHO alone as a diagnostic imaging could not help diagnosis, chest CT scan showed the aortic arch aneurysm which confirmed Diagnosis. Given the importance of this condition, with the element of suspicion, early and proper screening of patients with hemoptysis is mandatory.