A rare presentation of vena cava superior syndrome: ascending aorta dilatation

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A 72-year-old male patient with past medical history of hypertension and coronary artery disease was admitted to the emergency  clinic after two hours of acute-onset- edema of the lower part of the head and neck. The patient was using acetylsalicylic acid,  angiotensin converting inhibitor and beta blocker agents. On his physical examination, blood pressure and heart rates were 125/70  mmHg and 95 bpm, respectively. Heart and respiratory auscultation findings were normal. Electrocardiogram showed sinus rhythm.  The initial evaluation of the emergency physician was angioedema and patient was consulted to the dermatology. However,  there was an increase in clinical progression, head, and neck swelling in the patient. The patient was quickly drawn to computer  tomography. Computed tomography showed that the ascending aorta was highly dilated (Figure-1). The dilated ascending aorta  was obstructed by the vena cava superior (Figure-2 and Figure-3). It was also showed that the right atrium was pressed by the  dilated ascending aorta (Figure-4). Left ventricular systolic functions were normal in the echocardiography of the patient, and  ascending aortic diameter of 9.8 cm was measured in parasternal long axis images. The patient was immediately transferred to  cardiovascular surgery for surgical treatment purposes.

A 72-year-old male patient with past medical history of hypertension and coronary artery disease was admitted to the emergency clinic after two hours of acute-onset- edema of the lower part of the head and neck. The patient was using acetylsalicylic acid, angiotensin converting inhibitor and beta blocker agents. On his physical examination, blood pressure and heart rates were 125/70 mmHg and 95 bpm, respectively. Heart and respiratory auscultation findings were normal. Electrocardiogram showed sinus rhythm. The initial evaluation of the emergency physician was angioedema and patient was consulted to the dermatology. However, there was an increase in clinical progression, head, and neck swelling in the patient. The patient was quickly drawn to computer tomography. Computed tomography showed that the ascending aorta was highly dilated (Figure-1). The dilated ascending aorta was obstructed by the vena cava superior (Figure-2 and Figure-3). It was also showed that the right atrium was pressed by the dilated ascending aorta (Figure-4). Left ventricular systolic functions were normal in the echocardiography of the patient, and ascending aortic diameter of 9.8 cm was measured in parasternal long axis images. The patient was immediately transferred to cardiovascular surgery for surgical treatment purposes.

Additional Info

  • Recieved: 09.06.2018
  • Accepted: 26.06.2018
  • Published Online: 03.07.2018
  • Printed: 01.01.2020
  • DOI: 10.4328/ACAM.5928
  • Author: Yasemin Kaya, Ali Aygün, Sevda Önder, Hilal Altaş, İsmail Yıldız
  • Identifier: DOI: 10.4328/ACAM.5928
  • Index Page: -
  • How to Cite: Yasemin Kaya, Ali Aygün, Sevda Önder, Hilal Altaş, İsmail Yıldız. A rare presentation of vena cava superior syndrome: ascending aorta dilatation. Ann Clin Anal Med 2019; DOI: 10.4328/ACAM.6088.
  • Running Title: Vena cava superior syndrome and ascending aorta dilatation

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