A 55-year-old Man with Ruptured of Standford Type B Aortic Dissection Presenting with Bilateral Hemothorax

Author : I.Tania, R. Ashriyah
Upload Date : 19-04-2018

Background. Aortic dissection is a very rare case that requires prompt diagnosis and treatment. Rupture of aortic dissection is still being the catasthropic complication that can cause death within hours. Herein we present infrequent case of ruptured Standford Type B aortic dissection which caused bilateral hemothorax.

Case Report. A 55-year-old man with a history of hypertension was admitted to our emergency room with sudden onset of ripping chest pain radiating to the back since the last 2 hours. Upon admission his condition represented hemodynamic instability with blood pressure 80/40 mmHg, heart rate 142 beats/min and respiratory rate 36 times/min. His peripheral pulse was weakly palpable with cold extremities. Laboratory study revealed that his hemoglobin was declined to 9.5 g/L and his ECG showed anterolateral ischemic sign. Chest X-ray demonstrated widening mediastinum  and blunting of left costophrenic angle. With suspicion of aortic rupture, CT scan with contrast was obtained. CT scan revealed aortic dissection began from 2 cms distal of aortic arch. There was intramural hematome (IMH) and/or penetrating aortic ulcer (PAU) along descending aorta at once with rupture to the both pleural cavity. Thereby, CT scan confirmed there was bilateral hemothorax due to ruptured type B aortic dissection.

Summary. Computed tomography is valuable in localizing the dissection and rupture site of aortic dissection. Prompt diagnosis can lead to prompt definitive treatment.

KEYWORDS : acute aortic syndrome,intramural hematome, penetrating aortic ulcer, ruptured aortic dissection, computed tomography, hemothorax

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