Aortic Aneurysm in a 33-Year-Old Male
I am a 33-year-old male, standing at 5'11" and weighing 185 pounds, with no ongoing medications and a non-smoking history. Recently, I received a diagnosis of a 44 mm aortic root aneurysm. To provide some context, the investigation began after I experienced my first syncope six hours post my second COVID vaccination in 2022. Six months later, I had another syncopal episode and ended up in the emergency department, where I tested positive for COVID despite showing no symptoms. Over the following years, I faced multiple presyncopal incidents accompanied by palpitations, yet my cardiac evaluations—including a CT scan, lab tests, echocardiogram, and Holter monitor—returned negative results. A month ago, while I was sleeping, my wife, who works as a nurse in cardiothoracic intensive care, thought she detected a rapid arrhythmia while resting her head near my chest. Upon waking, I experienced palpitations but didn't overthink it. She encouraged me to seek further assessment. Subsequently, I underwent another ZioPatch monitoring, which indicated heightened ventricular ectopy, revealing runs of up to five beats as well as isolated premature atrial contractions (PACs). A CT scan following this found a 44 mm aortic root aneurysm located at the sinus of Valsalva. An echocardiogram I had following the CT appeared normal, while a nuclear stress test indicated heterogeneous tracer uptake. My coronary arteries were clear based on my CT angiography, and I had a calcium score of zero. I am currently awaiting an appointment with a specialist and have some questions that I hope to clarify: 1. Are there any recorded instances where COVID-19 has been linked to the development of aortic aneurysms? It feels too coincidental that I was in good health until the day I got my second vaccine. 2. Could the aneurysm be responsible for the ventricular arrhythmias? I did not notice palpitations while connected to the monitor. My wife worries that I might be experiencing longer episodes of ventricular tachycardia (VT) that could lead to syncope. 3. What might be the source of the aforementioned heterogeneous tracer uptake? My wife, who might be the one crafting this message, has encountered a case of aortic angiosarcoma and is quite anxious about it.
Answers (1)
7/11/2025, 2:30:56 AM
OpenHealth AI
Thank you for sharing your experience and concerns. It's completely understandable to seek clarity about your recent diagnosis of a 44 mm aortic root aneurysm and the related symptoms you've been experiencing. Let’s address your questions and outline some actionable next steps.
Key Points:
- There is currently no established link between COVID-19 vaccination and the development of aortic aneurysms.
- The aneurysm could potentially be related to your arrhythmias, but further evaluation is necessary.
- Heterogeneous tracer uptake can have various causes and typically requires further investigation.
Explanation:
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COVID-19 and Aortic Aneurysms: There are no direct studies linking COVID-19 vaccines to the formation of aortic aneurysms. While it’s natural to feel that the timing of your symptoms is related to the vaccination, most data suggest that existing factors such as genetics, blood pressure, or other health issues are more likely contributors to an aneurysm's development.
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Aneurysm and Arrhythmias: While aortic aneurysms can be associated with cardiac symptoms, including arrhythmias, it doesn’t mean that the aneurysm is the primary cause of your ventricular ectopy. Your thorough cardiac evaluations are reassuring, but the connection can be complex. Your upcoming consultation with a specialist will provide more tailored insights.
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Heterogeneous Tracer Uptake: This can indicate a variety of conditions, including but not limited to inflammation, myocardial ischemia, or cardiac stress. It’s essential to discuss these results comprehensively with your healthcare provider to determine if further testing is needed.
Next Steps:
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Continue Monitoring: While you await your specialist appointment, keep a record of your symptoms, including any palpitations or syncopal episodes. Noting their frequency, duration, and circumstances can provide valuable information to your doctor.
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Maintain Health: Focus on a heart-healthy lifestyle:
- Diet: Consume a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while limiting saturated fats and sugars.
- Exercise: If cleared by your doctor, gentle cardiovascular exercises, such as walking or cycling, can be beneficial.
- Stress Management: Engage in stress-reducing practices like mindfulness or relaxation techniques.
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Stay Informed: Prepare specific questions for your upcoming specialist appointment, particularly regarding the management of your aneurysm, potential arrhythmias, and the implications of the heterogeneous uptake. This can help alleviate concerns and clarify the next steps in your care.
It's good to acknowledge your concerns, especially with a family member in healthcare. Rest assured that a thorough approach by your specialist will provide you with the appropriate course of action. If you have more questions or need further clarification, don’t hesitate to ask.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.