A 51-year-old female patient was referred to our hospital for further assessment of the mediastinal mass found incidentally on computed tomography examination at another hospital. She had no history of hypertension, trauma or aortic arch surgery. Physical examination, 12-lead electrocardiogram, and routine laboratory investigations were unremarkable.
An oval hypoechoic mass with clear borders and heavy calcifications, measuring 6.5 × 4.4 × 3.4cm, was noted on transthoracic echocardiography from the suprasternal window (Panel A, yellow arrows). Color flow Doppler imaging showed a weak blood flow signal in the mass (Panel B, red arrow). Contrast-enhanced echocardiography was further performed, which revealed that the swirling of contrast agent in the mass (Panel C, red arrows). More importantly, a small number of contrast agent from the lesser curvature of the distal aortic arch entering into the mass during systole were visualized (Panel D, red arrow). Based on the aforementioned findings, a preliminary diagnosis of an aortic arch pseudoaneurysm with mural thrombosis and massive calcifications was made. The patient subsequently underwent computed tomography angiography which confirmed the presence of aortic arch pseudoaneurysm. (Panel E-H). To prevent rupture of the pseudoaneurysm, the patient underwent surgical intervention (Panel I, yellow arrow pointing to the pseudoaneurysm). A covered stent-graft was placed in the aortic arch for endovascular repair. The postoperative course was uneventful.
We report a case of a pseudoaneurysm of aortic arch first suspected by contrast-enhanced echocardiography and finally diagnosed by CTA. The value of CTA and magnetic resonance imaging in the diagnosis of aortic arch pseudoaneurysms has been widely recognized, while contrast-enhanced echocardiography has not gained much attention. Contrast-enhanced echocardiography has the advantage of being bedside, portable, and easily available. It can allow clear visualization of the location, dimensions, extension, and neck of the pseudoaneurysm. It may be regarded as a complementary imaging method for the diagnosis of aortic arch pseudoaneurysm, especially for critically ill patients who cannot undergo CTA and magnetic resonance imaging examinations.