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A 56 year old man who had had a stroke 10 years previously presented with transient ischaemic attack (TIA). Chest radiography showed a large mass in the right upper hemithorax measuring 12 × 6 cm. Because of chronic renal failure magnetic resonance imaging (MRI) was performed. The coronal MRIs (dark blood T2 weighted turbo spin-echo MRI) showed a saccular aneurysmatic protrusion of the aortic wall originating from the right border of the aortic arch. A large part of the aneurysm was not perfused and was thrombosed in layers (arrowheads). The perfused lumen (arrow) of the true aneurysm measured 3 × 4 cm. The TIA occurred because of the multiple sources of emboli and the carotid stenosis. Oral anticoagulation was prescribed.
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