A 45-year-old was presented with swelling on the right side of the chest for last 3 months before presentation. The patient had a history of untreated syphilis. Examination The chest swelling was pulsatile and in the right infraclavicular area. Cardiac examination was normal. Chest X-ray showed mediastinal widening. An echocardiogram revealed mild aortic regurgitation with an aneurysm of the ascending aorta.
Contrast enhanced CT imaging showed a large aneurysm (9.2 cm × 11.3 cm × 5.8 cm). Panel C image indicates (from L -R) right anterior oblique view, the anteroposterior view, and the left anterior oblique view. The aneurysm was eroding the right half of the manubrium of sternum and the adjacent first and second costochondral junctions. Compression of the trachea, pulmonary artery, superior vena cava, and esophagus was noted. What is the most likely reason for the pulsatile chest…
