Case Report: Persistent Fifth Aortic Arch Presenting as a Giant Ascending Aortic Aneurysm: Diagnostic Challenge and Surgical Resolution with Bentall Procedure

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ID: 313768
2026
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Abstract
Abstract Background An ascending aortic aneurysm is defined as dilatation of the ascending aorta to ≥1.5 times its normal diameter. Surgical intervention is recommended when the diameter exceeds 55 mm to prevent life-threatening complications such as rupture or dissection. Persistent fifth aortic arch is a rare congenital vascular anomaly, which may present as a dual-lumen aortic configuration and can mimic acquired pathological conditions such as aortic dissection or aneurysm, posing a diagnostic challenge. Case Summary (final revised version) A 39-year-old male with long-standing hypertension presented with cough and shortness of breath. Initial computed tomography performed to exclude pulmonary embolism incidentally revealed a markedly dilated ascending aorta. Following intensive care unit admission and stabilization, echocardiography and CT aortography demonstrated severe aortic regurgitation and a giant ascending aortic aneurysm measuring 10.5 cm with dual-lumen morphology interpreted radiologically as Stanford type A aortic dissection. The patient underwent urgent Bentall procedure. Histopathological examination confirmed a dual-lumen vascular structure consistent with persistent fifth aortic arch, establishing the congenital etiology. The patient recovered uneventfully and remained asymptomatic during cardiothoracic follow-up. Conclusion (final revised version) This case highlights the diagnostic challenge of distinguishing congenital persistent fifth aortic arch from acquired aortic dissection in the setting of a giant ascending aneurysm. Despite radiologic ambiguity, prompt surgical repair was definitive. Histopathological confirmation provided etiologic clarity and contributes to understanding the natural history of this rare anomaly.
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Authors Abdelrahman Waleed Alsayed Manaa, Mokhtar Kahin, MUKHTAR METWALLY, Rafat Abu Shakra, Walid Abu Khudair
Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag330
URL
https://doi.org/10.1093/ehjcr/ytag330
Keywords Keywords not found

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