A 67 year old man with an aortic prosthetic tube implanted after being diagnosed with an ascending aortic aneurysm and secondary severe aortic insufficiency complained of progressive dyspnoea, orthopnoea, and episodes of intense, sharp interscapular pain unrelated to exercise irradiating to the precordium. He developed severe hypoxaemia which required orotracheal intubation and mechanical ventilation. Transoesophageal echocardiography detected a pseudoaneurysm (Ps) with a diameter of 12 cm around the aortic tube (AoT) with thrombus inside. A fistula connecting the pseudoaneurysm with the right pulmonary artery (RPA) was suggested by the initial image (upper panel, arrow) and was demonstrated by colour Doppler (lower panel). Emergency surgery was indicated, but suddenly the patient had a profuse serohaematic secretion through the endotracheal tube, suffered severe hypotension and hypoxaemia that did not respond to treatment, and he died.
