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Hemodynamically asymptomatic spontaneous rupture of the descending thoracic aorta masquerading as a lung mass.

Mehta S, Harshvardhan L, Gupta N, Kaushik D, Mangalam AN - Lung India (2015 Mar-Apr)

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India. E-mail: s.smehta@hotmail.com.

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Sir, The rupture of the aorta is considered to be spontaneous if it occurs in the absence of thoracic trauma or a pre-existing aortic pathology... The cardiovascular system examination was within normal limits... The respiratory system examination revealed decreased air entry in the left infrascapular region, with reduced vocal fremitus and reduced vocal resonance... CT angiography of the aorta was then obtained, which showed a 10 mm vent in the left posterolateral wall [Figure 3] of the descending thoracic aorta, with diffuse atherosclerotic plaques in the ascending, transverse arch, and descending aorta... Spontaneous aortic rupture is an extremely rare disorder with less than 40 cases reported worldwide... First was the absence of a pre-existing comorbidity in our patient... In an analysis of 18 patients, Yokoyama et al., found that 72% of the patients had a history of hypertension, two patients had rheumatoid arthritis and were on long-term steroids, and only three patients had no associated comorbidity... Second, the presenting symptom of pain in the left upper abdomen, of a 20-day duration, with no associated hemodynamic compromise, also contrasted with the previously reported cases, wherein, 78% of the patients had severe acute chest pain associated with shock... The cause behind a spontaneous aortic rupture is possibly a penetrating atherosclerotic aortic ulcer... In our patient, the angiography had revealed diffuse atherosclerotic plaques in the entire aorta, which may have been the culprits for the rupture... Unfortunately she was lost to follow-up... To conclude, we would like to state that spontaneous aortic rupture is an extremely rare entity, which presents a diagnostic challenge, particularly if the presentation is atypical... Prompt diagnosis and early surgical intervention can greatly reduce the associated mortality.

No MeSH data available.


Related in: MedlinePlus

CT aortography with 3D reconstruction showing a 10 mm vent (arrow) in the left posterolateral wall of the thoracic descending aorta
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Figure 3: CT aortography with 3D reconstruction showing a 10 mm vent (arrow) in the left posterolateral wall of the thoracic descending aorta

Mentions: A 50-year-old smoker, postmenopausal female patient, presented with a complaint of pain in the left upper abdomen, of a 20-day duration. The pain was a dull ache, which was continuous, nonprogressive, and nonradiating, with no aggravating or relieving factors, and was not relieved by painkillers. On examination, the patient had a pulse rate of 78/minute and blood pressure of 120/84 in the left upper limb, 118/78 in the right upper limb, and 128/86 in both lower limbs. The cardiovascular system examination was within normal limits. The respiratory system examination revealed decreased air entry in the left infrascapular region, with reduced vocal fremitus and reduced vocal resonance. A chest roentgenogram was suggestive of a homogenous opacity in the left lung, abutting the cardiac shadow, suggestive of a mass lesion in the left lower lobe region [Figure 1]. Assuming the lesion to be a lung mass, contrast-enhanced computed tomography (CECT) imaging of the thorax was done, which revealed a ruptured thoracic aorta through its posterolateral wall, with an active contrast leak, and an organized hematoma [Figure 2]. CT angiography of the aorta was then obtained, which showed a 10 mm vent in the left posterolateral wall [Figure 3] of the descending thoracic aorta, with diffuse atherosclerotic plaques in the ascending, transverse arch, and descending aorta.


Hemodynamically asymptomatic spontaneous rupture of the descending thoracic aorta masquerading as a lung mass.

Mehta S, Harshvardhan L, Gupta N, Kaushik D, Mangalam AN - Lung India (2015 Mar-Apr)

CT aortography with 3D reconstruction showing a 10 mm vent (arrow) in the left posterolateral wall of the thoracic descending aorta
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372883&req=5

Figure 3: CT aortography with 3D reconstruction showing a 10 mm vent (arrow) in the left posterolateral wall of the thoracic descending aorta
Mentions: A 50-year-old smoker, postmenopausal female patient, presented with a complaint of pain in the left upper abdomen, of a 20-day duration. The pain was a dull ache, which was continuous, nonprogressive, and nonradiating, with no aggravating or relieving factors, and was not relieved by painkillers. On examination, the patient had a pulse rate of 78/minute and blood pressure of 120/84 in the left upper limb, 118/78 in the right upper limb, and 128/86 in both lower limbs. The cardiovascular system examination was within normal limits. The respiratory system examination revealed decreased air entry in the left infrascapular region, with reduced vocal fremitus and reduced vocal resonance. A chest roentgenogram was suggestive of a homogenous opacity in the left lung, abutting the cardiac shadow, suggestive of a mass lesion in the left lower lobe region [Figure 1]. Assuming the lesion to be a lung mass, contrast-enhanced computed tomography (CECT) imaging of the thorax was done, which revealed a ruptured thoracic aorta through its posterolateral wall, with an active contrast leak, and an organized hematoma [Figure 2]. CT angiography of the aorta was then obtained, which showed a 10 mm vent in the left posterolateral wall [Figure 3] of the descending thoracic aorta, with diffuse atherosclerotic plaques in the ascending, transverse arch, and descending aorta.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India. E-mail: s.smehta@hotmail.com.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, The rupture of the aorta is considered to be spontaneous if it occurs in the absence of thoracic trauma or a pre-existing aortic pathology... The cardiovascular system examination was within normal limits... The respiratory system examination revealed decreased air entry in the left infrascapular region, with reduced vocal fremitus and reduced vocal resonance... CT angiography of the aorta was then obtained, which showed a 10 mm vent in the left posterolateral wall [Figure 3] of the descending thoracic aorta, with diffuse atherosclerotic plaques in the ascending, transverse arch, and descending aorta... Spontaneous aortic rupture is an extremely rare disorder with less than 40 cases reported worldwide... First was the absence of a pre-existing comorbidity in our patient... In an analysis of 18 patients, Yokoyama et al., found that 72% of the patients had a history of hypertension, two patients had rheumatoid arthritis and were on long-term steroids, and only three patients had no associated comorbidity... Second, the presenting symptom of pain in the left upper abdomen, of a 20-day duration, with no associated hemodynamic compromise, also contrasted with the previously reported cases, wherein, 78% of the patients had severe acute chest pain associated with shock... The cause behind a spontaneous aortic rupture is possibly a penetrating atherosclerotic aortic ulcer... In our patient, the angiography had revealed diffuse atherosclerotic plaques in the entire aorta, which may have been the culprits for the rupture... Unfortunately she was lost to follow-up... To conclude, we would like to state that spontaneous aortic rupture is an extremely rare entity, which presents a diagnostic challenge, particularly if the presentation is atypical... Prompt diagnosis and early surgical intervention can greatly reduce the associated mortality.

No MeSH data available.


Related in: MedlinePlus