Penetrating aortic atherosclerotic ulcer in the ascending aorta with rupture saccular aneurysm
Presentation
Chest pain.
Patient Data
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
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.