Chronic traumatic aneurysm of the descending thoracic aorta with compression of the tracheobronchial tree.

A 60-year-old man was admitted to the emergency department in severe respiratory distress. He had been involved in a major motorcycle accident, 43 years earlier. A plain chest film showed a calcified mediastinal mass close to the aortic knob and displacement of the trachea and the opaque nasogastric tube to the right. The aortogram showed a 9-cm saccular aneurysm situated at the isthmus. At thoracotomy, the descending thoracic aorta was found to be transected through 60% of its circumference. The ends of the transected intimal and medial layers of the aortic wall were 6 cm apart and a false aneurysm, which was calcified and full of old and new clot, was compressing the left main bronchus and the pulmonary artery. With protection from a Gott shunt inserted between the ascending and the descending portions, the aorta was successfully repaired with an interposition Dacron graft.