Aorta, the major conductance vessel of the body, can be affected by a variety of pathologic processes leading to aneurysm, dissection, or ischemic syndromes. There has been a drastic increase in the incidence of aortic aneurysm making it the 18th most common cause for death. When ignored, the patients’ condition might worsen leading to death due to rupture and hemorrhage. Here we report a case of ascending aortic aneurysm affecting the aortic root and proximal part of ascending aorta. Conscious awareness of this pathological process augments a great deal to radiologists and sonographers during various imaging techniques and rescues the patient from aneurysm-related deaths.

1. Ascending aortic aneurysm and its clinical
significance: A case report

2. Case Report
Ascending aortic aneurysm and its clinical
significance: A case report
Saju B. Cherian a,
*, Aruna Jyothi Gandhalam b
, M. Bhavani c
,
P. Rohit Kumar d
, Vaishnavi Reddy d
a
Assistant Professor, Department of Anatomy, Apollo Institute of Medical Sciences and Research, Hyderabad, India
b
Professor, Department of Anatomy, Apollo Institute of Medical Sciences and Research, Hyderabad, India
c
Associate Professor, Department of Pathology, Apollo Institute of Medical Sciences and Research, Hyderabad, India
d
First Year MBBS Student, Apollo Institute of Medical Sciences and Research, Hyderabad, India
1. Case report
During routine dissection classes held for medical under-
graduates at Apollo Institute of Medical Sciences and Research,
Hyderabad, we observed a distinct dilatation at the proximal
part of aorta in a 65-year-old, well-built female cadaver. Its
diameter was almost equal to that of right atrium and was
initially mistaken for the same (Fig. 1). Later, the bulge appeared
to be a fusiform dilatation in the ascending portion of aorta
extending till the aortic arch was measuring about 20 cm in its
broadest part (Fig. 2). The circumference at the annulus and root
of aorta measured about 13.5 cm. The brachiocephalic trunk
also appeared to have a dilated wall measuring about 6.5 cm at
its root. The right and left ventricles appeared to be normal. A
part of descending aorta was opened and multiple plaques were
observed within the lumen of the vessel (Fig. 3) and the tissue
was sent for histopathological sectioning.
2. Discussion
Aortic aneurysm is defined as the localized or diffuse
dilatation of more than 50% normal diameter of aorta.1
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x
a r t i c l e i n f o
Article history:
Received 1 July 2015
Accepted 22 July 2015
Available online xxx
Keywords:
Aneurysm
Aorta
Ascending aorta
Thoracic aortic aneurysm
Ascending aortic aneurysm
a b s t r a c t
Aorta, the major conductance vessel of the body, can be affected by a variety of pathologic
processes leading to aneurysm, dissection, or ischemic syndromes. There has been a drastic
increase in the incidence of aortic aneurysm making it the 18th most common cause
for death.
When ignored, the patients' condition might worsen leading to death due to rupture and
hemorrhage. Here we report a case of ascending aortic aneurysm affecting the aortic root
and proximal part of ascending aorta. Conscious awareness of this pathological process
augments a great deal to radiologists and sonographers during various imaging techniques
and rescues the patient from aneurysm-related deaths.
# 2015 Indraprastha Medical Corporation Ltd. Published by Elsevier B.V. All rights
reserved.
* Corresponding author at: Department of Anatomy, Apollo Institute of Medical Sciences and Research, Jubilee Hills, Hyderabad 500096,
India. Tel.: +91 9573564627.
E-mail address: sajubinu@gmail.com (S.B. Cherian).
APME-305; No. of Pages 3
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(2015), http://dx.doi.org/10.1016/j.apme.2015.07.009
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3. It has been estimated that 1–2% of the population harbor
aneurysms in their aorta, with up to 10% prevalence in older
age groups.2
Aneurysms may be hereditary.3
Most aortic aneurysms go undetected until rupture, and the
mortality from ruptured aneurysms is as high as 90%2
and
hence referred to as 'silent killer'.4
Aortic aneurysms are
classified based on the segment involved as thoracic,
thoracoabdominal, or abdominal.5
Thoracic aortic aneurysm
is much less common in occurrence when compared to
abdominal aortic aneurysm with the incidence of 50%
involving the ascending aorta, 10% of the arch, and 40% of
the descending thoracic aorta.2
Although a virulent disease,
thoracic aortic aneurysm grows in an indolent fashion.6
It is
often associated with a condition termed cystic medial
necrosis (CMD),6,7
a normal physiologic process of aging.
CMD is characterized by accumulation of basophilic ground
substances, composed of proteoglycans, in arteries, and in
particular the aorta. CMD is known to occur in some of the
diseases associated with connective tissue degeneration and
damage, such as Marfan's syndrome (defect in synthesis of
fibrillin-1)8
and Ehlers–Danlos syndrome. Mutations result in a
marked decrease in elastin aortic wall as well as increase in
elastic properties that lead to progressive increase in stiffness
and dilation.4
Ascending aortic aneurysm may also occur in
patients who lack connective tissue disorders.4
It occurs more
frequently and at a younger age in patients with bicuspid
aortic valves (BAV) than it does in patients with normal
trileaflet aortic valves (TAV).9
Histologically, when the walls of the aneurysm have all
three layers, they are called true aneurysms. If the wall of the
aneurysm has only the outer layer remaining, it is called a
pseudoaneurysm. Pseudoaneurysms may occur as a result of
trauma when the inner layers are torn apart. Most fusiform
aneurysms are true aneurysms. The weakness is often along
an extended section of the aorta and involves the entire
circumference of the aorta. The weakened portion appears as a
generally symmetrical bulge. Degenerative aneurysms are the
most common types of aneurysms. They occur as the result of
breakdown of the connective tissue and muscular layer.
Histologically, the wall of the aneurysm revealed thinned
out tunica media, loss of smooth muscle cells, reduced elastic
fibers, with fibro-connective tissue, and fragmentation of
elastic fibers, calcification, and atherosclerotic changes. There
was no evidence of dissection. In the present case, it could be
fusiform degenerative aneurysm. The cause could be high
blood pressure and/or genetic/inflammatory conditions. There
Fig. 1 – Sternocostal surface of heart. Note the thoracic aortic
aneurysm (TAA) in the proximal part of aorta. Aortic arch
(AA) with brachiocephalic trunk (BT); Left common carotid
artery (LCC) can be seen. Descending aorta (DA) and
pulmonary trunk (PT) are normal.
Fig. 2 – Lateral view of heart showing ascending aortic
aneurysm (AAA). Note the size of the dilated vessel wall in
comparison to the right atrium (RA).
Fig. 3 – Severe atherosclerosis seen in the vessel wall.
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x2
APME-305; No. of Pages 3
Please cite this article in press as: Cherian SB, et al. Ascending aortic aneurysm and its clinical significance: A case report, Apollo Med.
(2015), http://dx.doi.org/10.1016/j.apme.2015.07.009

4. were no definitive physical characteristics to suggest that the
victim was suffering from either Ehlers–Danlos syndrome or
Marfan's syndrome.
Conscious awareness of this finding is very important for
radiologists while performing the various imaging technolo-
gies like scan, echocardiography (echo), computed tomogra-
phy (CT),3
and magnetic resonance imaging (MRI). It is of vital
importance to extirpate the thoracic aortic aneurysm before
rupture or dissection10
occurs to prevent the patient from
needless death.
3. Conclusion
Fusiform degenerative aneurysm, a category of ascending
aortic aneurysm, is an enlargement of both aortic annulus and
proximal portion of aorta characterized by aortic regurgitation.
Awareness of this vascular pathology is of crucial importance
to radiologists, cardiologists, and sonographers, and if ignored
can lead to rupture and dissection, which can be fatal.
Furthermore, the clinician should realize that first-degree
relatives of patients with thoracic aortic dilatation are also at
risk and should be evaluated for manifestations of connective
tissue disorders.
Conflicts of interest
The authors have none to declare.
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a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x 3
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(2015), http://dx.doi.org/10.1016/j.apme.2015.07.009

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