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Requests for reprints should be addressed to Ken Nagahata, MD, Department of Rheumatology and Clinical Immunology, Sapporo Medical University School of Medicine, South 1‑West 16, Chuo-ku, Sapporo, Hokkaido, Japan 060‑8543.
Department of Rheumatology and Clinical Immunology, School of Medicine, Sapporo Medical University, Sapporo, JapanDepartment of Internal Medicine, JYUKEIKAI Ishida Hospital, Nakashibetsu, Japan
An 82-year-old woman presented with intermittent fever and left rib pain for the past
several weeks. She had been diagnosed with polymyalgia rheumatica 18 months prior
and was taking prednisolone; she also had a history of urinary tract infection with
Escherichia coli 6 months earlier. Physical examination did not reveal a heart murmur. Laboratory
investigations showed noticeably elevated inflammatory markers (C-reactive protein,
26 mg/dL; erythrocyte sedimentation rate, 103 mm/h). Plain chest computed tomography
showed no significant findings related to the chief complaints (FigureA).
Figure(A) A computed tomography scan showing no significant findings in the aortic arch at
the initial visit. (B) Three months later, a contrast-enhanced demonstrating rapid enlargement of a 61 × 40 mm
saccular, irregular aortic aneurysm protruding rightward from the aortic arch with
surrounding fluid effusion and soft-tissue swelling (arrows). (C) Upper gastrointestinal endoscopy revealing lateral compression and erosion of the
cervical esophagus.
