Aortic pseudoaneurysm misdiagnosed as lung cancer on unenhanced CT: a case report

Background: Pseudoaneurysm of the aorta is a condition in which the aortic wall is destroyed, but blood flow is not flowing and is unsafely trapped by an adjacent organ or perivascular hematoma. In this study, we describe a thoracic aortic pseudoaneurysm initially suspected to be left lower lobe lung cancer on non-contrast-enhanced computed tomography (CT). The patient received timely treatment, preventing severe hemoptysis. However, delayed diagnosis can be perilous. Case Description: We present a case of an 84-year-old woman with a history of thyroid cancer and bilateral vocal cord palsy, who presented with hemoptysis. Initially suspected to be lung cancer due to a mass lesion adjacent to the descending aorta, further evaluation with contrast-enhanced CT revealed a concealed rupture of the aorta. This case highlights the importance of contrast-enhanced imaging in evaluating masses adjacent to major mediastinal organs. Prompt diagnosis and intervention, in this case, led to successful thoracic endovascular aneurysm repair (TEVAR) and a favorable outcome. Conclusions: This case emphasizes the importance of contrast-enhanced imaging in evaluating masses adjacent to major mediastinal organs. Early recognition of concealed aortic ruptures can facilitate timely intervention and improve patient outcomes. Clinicians should maintain a high index of suspicion for aortic pathology in patients presenting with atypical radiological findings, even in the absence of classic symptoms.