Giant Ascending Aortic Aneurysm With Atypical Presentation as Abdominal Pain.

BACKGROUND: Ascending aortic aneurysms typically present with chest or back pain; however, atypical presentations may delay diagnosis. CASE SUMMARY: A 58-year-old woman presented with acute lower abdominal pain and diaphoresis. Hypertension and a new diastolic murmur prompted cardiology evaluation, revealing clinical signs of chronic severe aortic regurgitation. Imaging confirmed a giant ascending aortic aneurysm (89 × 83 mm) with severe aortic regurgitation. DISCUSSION: This case emphasizes atypical presentations of thoracic aortic disease, compensated high-risk anatomy, and timely referral to specialized aortic centers to facilitate definitive surgical care despite temporary institutional capacity constraints. TAKE-HOME MESSAGES: Giant ascending aortic aneurysms may remain clinically compensated despite high-risk anatomy and present atypically, requiring high clinical suspicion and early multimodality imaging. When definitive repair is delayed by system-level constraints, structured interim stabilization, surveillance, and referral coordination are critical.