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Background Giant aortic aneurysm is a rare clinical entity. They may present with typical features of chest pain, or most feared complications with dissection and rupture. However, an asymptomatic and unruptured giant thoracic aneurysm is extremely rare with only two case reports in the literature. Case presentation An 80-year-old lady admitted to a local district general hospital with a 5-day history of productive cough with shivers. She tested positive for COVID-19 on admission. Diagnostic workup demonstrated an incidental finding of a giant TAAA. Her case was referred to a tertiary hospital for vascular Multidisciplinary Team (MDT) discussion and planning. It was decided that for her to have pre-operative assessment and MDT discussion after her recovery from infection to have definitive management of the TAAA. The patient is currently being managed supportively in hospital. Discussion According to National Institute for Health and Care Excellence (NICE), asymptomatic and 5.5 cm or larger aneurysm should be considered for repair. The case should be discussed in terms of the overall balance of benefits and risks with repair and conservative management, based on the current status of health and the expected future health. In this case, it was deemed that the risk of proceeding with repair at present outweighed the benefits. Conclusion This case describes a rare incidental finding of a giant TAAA. It emphasises the importance of MDT approach to direct and achieve appropriate management for a complex TAAA. Care treatment prioritisation, surgical planning and full complement expertise are required in complex cases such as this.

EP.WE.173A Ticking Time Bomb – incidental finding of a giant thoracoabdominal aneurysm