Large Aortic Pseudoaneurysm, From Left Coronary Ostium, With Aortopulmonary Fistula 10 Years After Aortic Root Replacement for Type A Aortic Dissection

A 66-year-old man presented with anorexia, unexplained weight loss, worsening shortness of breath, and atrial fibrillation. Ten years before this presentation, he had undergone urgent aortic root replacement to treat an acute type A aortic dissection at a different center.Clinical examination revealed a systolic murmur (grade 3/6) and an early diastolic murmur. An initial chest radiograph did not show evidence of cardiac failure. With continued deterioration of his clinical state, a subsequent chest radiograph performed 7 months later showed cardiomegaly, pulmonary congestion, and a left pleural effusion. A diagnosis of congestive heart failure was made. Figures 1 and 2 show his chest radiographs first at initial presentation (Figure 1) and then 7 months later (Figure 2). The atrial fibrillation progressed from paroxysmal to persistent, with attempted cardioversions failing to restore sinus rhythm.Figure 1. First chest radiograph taken after presentation.Figure 2. Chest radiograph taken just before diagnosis with computed tomography.During this time, he experienced weight loss of 19 kg over a period of 8 weeks. A computed tomographic scan of his abdomen was performed to investigate a possible intra-abdominal tumor. It showed no evidence of intra-abdominal neoplasia. However, it revealed a nodule in the …