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Trepopnoea is a symptom often described in relation to heart failure especially in cases having right-sided pleural effusion or other forms of unilateral lung disease.1–3 A 50-year-old man with a history of development of severe breathlessness, profuse sweating, palpitations and dizziness on right decubitus position for the past 1–2 months was admitted with accelerated hypertension with acute pulmonary oedema. His blood pressure at the time of admission was 180/90 mm Hg, which dropped to 90/60 mm Hg every time the patient turned to the right lateral position. Echocardiography showed a large descending thoracic aortic aneurysm measuring 8.1×6.5 cm with spontaneous echo contrast and thrombus, compressing the left atrium and ventricle (figures 11–3, videos 1–2). CT scan confirmed the presence of a large descending thoracic aortic aneurysm compressing (arrow in figures) the lateral wall of left atrium and ventricle (figures 44–7). This aneurysm caused cardiac compression that worsened in the right lateral position explaining the postural variation of symptoms and hypotension. The patient underwent emergent surgical correction of the thoracoabdominal aorta because of the risk of impending rupture of the aneurysm; unfortunately, the patient died of disseminated intravascular coagulopathy 4 days later as a postoperative complication of surgery.
The occurrence of this symptom caused by cardiac compression by a large thoracic aneurysm has never been described and is an interesting addition to the list of possible causes, which may be helpful for cardiologists and chest physicians.
The authors would like to thank Dr Ravindran Rajendran for contributing to the concept of the manuscript and for having helped in patient care.
Competing interests: None declared.
Patient consent: Obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.