# A case of thoracic aortic aneurysm discovered following poor ventilation during induction of anesthesia

## TL;DR

A 90-year-old woman experienced ventilation difficulties during anesthesia, revealing a new thoracic aortic aneurysm causing tracheal compression.

## Contribution

Highlights a rare case of aortic aneurysm discovered due to ventilation issues during anesthesia induction.

## Key findings

- Ventilation difficulties during anesthesia led to the discovery of a thoracic aortic aneurysm.
- Tracheal compression was confirmed via bronchoscopy and CT imaging.
- Thoracic endovascular repair resolved the tracheal compression.

## Abstract

Several cases of tracheal stenosis due to thoracic aortic aneurysm have been reported. However, cases of aortic aneurysm discovered following ventilation difficulties immediately after the induction of general anesthesia are rare. The patient, a 90-year-old woman with a history of ascending aortic replacement for a thoracic aortic aneurysm, was scheduled for sternum infection debridement. During induction, adequate ventilation could not be achieved despite the use of positive pressure, even after tracheal intubation. Bronchoscopy showed tracheal compression, which was not apparent in preoperative evaluations. CT imaging on the day demonstrated that the compression was caused by a thoracic aortic aneurysm. A thoracic endovascular aneurysm repair was performed successfully, and the tracheal compression improved afterwards. Compression from outside the trachea should be considered as a potential cause of sudden ventilation difficulties. Particularly in patients with a history of aortic surgery, additional preoperative assessments should be considered.