A 47-year-old man, with a history of aortic valve replacement 28 years
earlier, was admitted to the emergency department with a right cervical
mass and a superior vena cava syndrome. Thoracic angio-CT revealed a
giant ascending aorta aneurysm, with an intramural thrombus and
dissection flap, compressing the superior vena cava. Emergency surgery
was performed, confirming those findings. The dissection had ruptured
but was contained by surrounding structures, creating a false-aneurysm
that compressed the superior vena cava. The aneurysm was excluded and
the aorta was replaced by a Dacron conduit, thereby decompressing the
upper mediastinum. The patient made an uneventful recovery.