A case of thoracic aortic aneurysm associated with atypical coarctation and kinking of the aortic arch

: The aneurysm associated with atypical coarctation and kinking of the aortic arch is rare. Authors experienced such a case and performed operation using bypass technique as below. A 17-year-old male admitted to the authors' hospital to undergo operation of the enlarging thoracic aneurysm. He was observed from his childhood diagnosed as the coarctation and kinking of the aortic arch. The chest X-ray films showed a mass shadow in the left superior mediastinum. It had been also diagnosed as having a small post-stenotic dilation of aortic arch. Recently the mass on the X-ray enlarged. He was diagnosed as an aneurysm located on aortic arch using MR-imaging and aortogram. The aneurysmectomy was performed because of the possibility of the aneurysmal rupture. Under the general anesthesia, extra-anatomical bypass was made between ascending aorta and descending aorta, and another one between the bypass and left common carotid like as T-shape, because the proximal aneurysm was very near located on the origin of left common carotid. The aneurysm was excised and woven Dacron graft was implanted. The post-operative course was uneventful. This case suggests the necessity of deliberate clinical observation using roentgenography for a case of kinking of the aortic arch.