Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 21 2 2026 04 26 Tortuous Descending Thoracic Aorta in a Patient with a History of Ascending Aorta Replacement as a Confounder in Transesophageal Echocardiographic Evaluation of the Left Atrium: A Procedural Challenge 169 173 Sahar Asl-fallah Cardiology Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran Ali Hosseinsabet Cardiology Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Shapoor Shirani Radiology Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran Alimohammad Hajizeinali Cardiology Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran 2025 08 28 2025 11 09 Descending thoracic aorta tortuosity results from elongation of the descending aorta and is associated with aging. It acts as a risk factor for challenging endovascular procedures and has prognostic significance. It may, however, sometimes present as a vascular mass in the mediastinum, distorting nearby cardiac chambers, which may confuse physicians during transesophageal echocardiography. We describe an elderly woman with severe descending thoracic aorta tortuosity presenting with a tubular vascular mass located behind the left atrium, exerting compression on it. Recognizing the potential echocardiographic presentation of aortic tortuosity can aid in the timely identification of this condition during transesophageal echocardiography. https://jthc.tums.ac.ir/index.php/jthc/article/view/2338 https://jthc.tums.ac.ir/index.php/jthc/article/download/2338/1264