Thoracic aortic aneurysm presenting with haemoptysis, weight loss, night sweats, and hilar mass.

摘要

A 22-year-old male smoker presented to hospital with a 2-week history of haemoptysis, on a background of being unwell for 2 months with lethargy, sweats, malaise, loss of appetite, and weight loss. He had raised inflammatory markers with an erythrocyte sedimentation rate of 75 mm/h, a C-reactive protein level of 188 mg/1 andawhite blood cell count ofll.3 X 10~9/l.His chestX-ray(fig. 1) showed a left hilar mass. The initial differential diagnosis included lymphoma, tuberculosis, or lung cancer, and in view of his haemoptysis, he was booked for a bronchoscopy. In line with the National Institute for Clinical Excellence lung cancer guidelines [ 1 ], a staging CT scan of his thorax and upper abdomen was organised prior to bronchoscopy. His CT scan (fig. 2) demonstrated that the hilar mass was a large pseudo-aneurysm of the upper thoracic aorta, with features suggestive of probable coarctation. The left lung and left main stem bronchus were compressed by the pseudo-aneurysm but there was no other focal abnormality within the lungs.