Penetrating aortic atherosclerotic ulcer in the ascending aorta with rupture saccular aneurysm
Diagnosis almost certain
Presentation
Chest pain.
Patient Data
Age: 80 years.
Gender: Male
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Contrast-filled out-pouching of the thickened aortic wall.
Aortic intramural hematoma (high-attenuation crescent sign). The calcified intima which is atheromatous and irregular is displaced inwardly.
Bilateral pleural effusion (30HU). High-density fluid within the pericardial cavity.
15 hours later
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On the follow-up study, the ulcer and aneurysm have increased in size. Increased pericardial fluid.
Case Discussion
Penetrating aortic atherosclerotic ulcer with rupture saccular aneurysm into the pericardial and pleural spaces. Differential diagnosis: aortic dissection (Stanford A) resulting in rupture.
Pericardiocentesis was performed demonstrating clotted blood. Unfortunately, the patient died 1 hour later.