A giant "twin" aneurysm of the thoracic aorta

An 86-year-old female patient was referred to our division with sudden chest pain. On chest x-ray, a huge dilation of the mediastinum was observed (A). The patient underwent emergent computed tomography of the chest (B), which revealed a giant aneurysm involving both the ascending and descending portions of the thoracic aorta, with a peculiar aspect similar to a “twin aorta” (C). The left chest cavity was almost entirely occupied by the 2 aneurysms. Because of the presence of left pleural fluid, an emergent procedure was proposed but was refused by the patient. Despite accurate pressure control and intensive care unit monitoring, the patient experienced irreversible sudden cardiac arrest the following night.