Pseudoaneurysm of Ascending Aorta with Extrinsic Compression of Left Main Coronary Artery

Pseudoaneurysm of ascending aorta carries high mortality and morbidity due to adhesions and compression over surrounding structures. It occurs either after some form of injury to aorta or after infectious pathology. Spontaneous pseudoaneuryms are very rare as are the extrinsic compression of left main coronary artery. We are presenting a case with both of these rare ties. Patient was a female of middle age presented with cough and a past history of treated pulmonary tuberculosis 12 years before. During evaluation by X-ray, CECT is a large pseudoaneurysm of ascending aorta with oval defect in posterior wall above sinotubular junction. It was compressing 90% of the left main coronary artery, occluding 100% of the right pulmonary artery with formation of collaterals to it from surrounding arteries. Active tuberculosis and syphilis were ruled out. Patient underwent excision of pseudoaneurysm, replacement of ascending aorta by Dacron graft and coronary artery bypass under TRCA and CPB. There was massive intraoperative bleeding, and patient died on the fourth day due to sepsis and ARDS.