Right pleural effusion. Large mass projects over the right upper chest.
Intramural aortic hematoma extends from the aortic arch to just below the level of the right inferior pulmonary vein. Beginning at the level of the carina, there is blood outside the aorta anterior to the spine, indicating aortic rupture. Small bilateral pleural effusions, both containing high-density blood. The right chest mass seen on the plain film is extremely dense, indicating that it is blood. The mass has an "extrapleural fat sign", i.e. there is inward displacement of the extrapleural fat by the hematoma, indicating that the hematoma is located outside the pleura.
Case Discussion
This case illustrates a ruptured aorta, with an intramural hematoma, and bleeding into the soft tissues around the aorta, the pleural space, and the extrapleural space.
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