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A 77-year-old hypertensive man was admitted in cardiology department with acute chest pain and dyspnea. In his past medical history, he underwent endovascular aortic repair with stent grafting for a DeBakey III aortic dissection at the age of 64. His physical examination as well as a 12-lead electrocardiogram were unremarkable. Laboratory tests showed normal troponin levels. Renal function tests were normal. Hemoglobin count was 8.9 g/dL. Echocardiography revealed a preserved left ventricular function, a mild pericardial effusion and most importantly a large peri-prosthetic aneurysm with partial semi-circumferential thrombosis, compressing the left ventricle and the left atrium. Computed tomography (CT) angiography of the chest showed the same huge, partially thrombosed aneurysm of the descending aorta with a mass effect on the neighboring mediastinal structures. The course was marked by the worsening of symptoms and the increase in the size of the aneurysm. Based on these findings, the patient was referred to urgent surgery. During the operation, the patient passed away due to a fatal bleeding.

We report the case of a 89 year-old woman admitted to the emergency department for epigastric pain, nausea, vomiting. Because of a circulatory failure with electrocardiographic ST changes and a slight elevation of ultra-sensible troponin, a coronary angiography was performed and found normal coronary arteries. Thoraco-abdominal CT scan revealed a large hiatal hernia causing a cardiac compression, and a left intraventricular obstruction showed by Doppler echocardiography. All signs resolved after fasting and gastric drainage., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)