Giant Ascending Aortic Aneurysm Revealed by Chronic Cough: A Case Report.

Ascending aortic aneurysms are potentially life-threatening conditions that often present with nonspecific symptoms. Giant aneurysms, defined by a diameter exceeding 10 cm, are rare and may lead to compressive symptoms. We report an unusual case of a giant ascending aortic aneurysm discovered during the evaluation of a chronic cough. We present the case of a 67-year-old woman who presented with a two-year history of persistent dry cough and exertional dyspnea. Physical examination revealed a diastolic murmur, and imaging studies identified a 10.2 × 10 cm ascending aortic aneurysm extending to the arch. Preoperative planning included femoral cannulation for extracorporeal circulation prior to anesthetic induction due to tracheal compression. Surgical replacement of the ascending aorta and arch was performed. Postoperatively, the patient developed a right hemiparesis and homonymous hemianopia due to ischemic cerebral lesions. This case highlights the diagnostic challenge posed by nonspecific respiratory symptoms in thoracic aortic aneurysms and the importance of early imaging. Airway compression by large aneurysms, though rare, should be considered in chronic cough of unclear etiology. Clinicians should maintain a high index of suspicion for mediastinal causes in a persistent, unexplained cough. Early use of chest CT can lead to the timely diagnosis of potentially fatal conditions such as giant thoracic aortic aneurysms. Optimal surgical planning and multidisciplinary management are essential to improve outcomes.