Spontaneous giant pseudoaneurysm in the upper segment of the aortic arch

A 57-year-old male patient was referred to the Department of Emergency with a chief complaint of a 2-month history of back pain and short of breath for 1 day. Meanwhile, he developed hypertension 1 month ago that was not treated. The patient denied any history of trauma, operation, allergy, any types of hepatitis, or other potential infectious diseases. Thoracic computed tomography angiography on admission indicated a giant pseudoaneurysm in the upper segment of the aortic arch with a maximum cross-sectional area of 93×98 mm and formation of inner arterial wall thrombus that compressed the trachea and esophagus, causing displacement of the esophagus and tracheal stenosis. Three original arterial bifurcation branches from the aortic arch were initiating from the aortic pseudoaneurysm, with the proximal part of the left common carotid artery narrowing down (Fig. 1a, 1b).