Aortic Dissection With Pseudoaneurysm Formation Masquerading as Pulmonary Embolism After Transcatheter Aortic Valve Replacement.

Transcatheter aortic valve replacement (TAVR) is a commonly performed procedure for the treatment of severe aortic stenosis. While it is generally considered a low-risk procedure, one of the rare potentially life-threatening complications includes aortic dissection. We report the case of a 75-year-old immunocompromised female who presented 2 weeks post-TAVR with persistent and worsening dyspnea, intermittent chest pain, and hypoxia. The patient's symptoms and risk factors increased the suspicion for pulmonary embolism, and initial imaging was supportive of the diagnosis. Management with therapeutic anticoagulation did not resolve the symptoms, and the patient developed acute-onset anemia. Further investigation revealed an aneurysmal dilation and dissection of the ascending thoracic aorta with pseudoaneurysm causing near-complete obstruction of the right pulmonary artery. This case highlights the diagnostic challenges of a rare and delayed post-TAVR complication and describes a unique presentation of aortic dissection. Post-operative complications should be considered in diagnosis even weeks after the procedure.