In late August, a 64-year-old male from Champawat, Uttarakhand, with a history of smoking, hypertension, and coronary artery disease presented with suspected left-sided pleural effusion, which was refuted upon review of the chest X-ray. His symptoms included chronic chest pain worsening over the past week and lower limb claudication. A 2D echocardiogram revealed elevated right heart pressures and a mass compressing the pulmonary artery, prompting a CT thorax that diagnosed a large fusiform thoracic aortic aneurysm with extensive mural thrombus.

Due to renal concerns, MR angiography was conducted, confirming the diagnosis. Immediate referral to Medanta Hospital for cardiac surgery was initiated, but due to financial constraints, the patient left against medical advice and tragically passed away within 72 hours of initial evaluation.

This case highlights the critical role of accurate diagnosis and timely intervention in managing complex cardiovascular conditions, underscoring the challenges posed by socioeconomic factors in accessing specialized care and affecting clinical outcomes.