Images in Clinical Medicine
Cardiac Compression by a Ruptured Aneurysm of the Descending Thoracic Aorta
N Engl J Med 2003; 348:1776May 1, 2003
- Article
A 68-year-old man presented with acute thoracic, abdominal, and back pain and progressive shock. In the past, he had undergone repair of an abdominal aortic aneurysm, bilobar wedge resection, and chest-wall resection because of a left-sided Pancoast's tumor. At that time, the thoracic aorta measured 5.6 cm in diameter just above the diaphragm, but there was kinking in the lower third of the descending aorta with a large mural thrombus (Panel A). On admission, physical examination revealed a cyanotic face and neck with distended neck veins. The blood pressure was 88/47 mm Hg. Computed tomographic scanning revealed a ruptured aneurysm of the descending thoracic aorta with a diameter of 6.5 cm. The aneurysm was leaking just above the thoracoabdominal junction, and the heart was compressed by a massive dorsal hematoma (Panel B) in a manner resembling cardiac tamponade. The patient underwent urgent replacement of the thoracoabdominal aorta. He survived surgery but died of myocardial infarction three days later.
Jurg Schmidli, M.D.
Thierry Carrel, M.D.
University Hospital, CH-3010 Berne, Switzerland- Citing Articles (1)
Citing Articles
1
J.A. Hermida Pérez, A. Bermejo Hernández, J.S. Hernández Guerra, R. Arroyo Diaz. (2012) Tumor del vértice pulmonar derecho que produce un síndrome de Pancoast. Descripción de un caso clínico. SEMERGEN - Medicina de Familia
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