대한흉부영상의학회 Weekly Chest Cases

Courtesy of Bae Young Lee, MD / St. Paul’s Hospital, College of Medicine, The Catholic Univesity of Korea
Age/Sex 81 / M
Chief ComplaintChest pain and left apical mass on chest AP History of hypertension, Blood Pressure at admission was 140/70

Diagnosis: Spontaneous Rupture of Descending Thoracic Aorta with Hemothorax and Hemomediastinum
Radiologic Findings: Anteroposterior chest radiograph at admission shows widened mediastinum and mass shadow in left apex. Follow up chest radiograph (24 hours later) additionally shows bilateral pleural effusion. Unenhanced CT scan shows high attenuation in aorta wall, mediastinum, and pleural space. MPR image (oblique sagittal plane) shows contrast leakage in hematoma at superior aspect of thoracic aorta distal to orifice of left subclavian artery.
Brief Review: Most of spontaneous aortic rupture are believed to be associated with perforation through the atheromatous plaque. The proposed mechanism for rupture is pressure atrophy of the media due to overlying intimal atherosclerotic plaque with localized distension of the aortic wall resulting from intramural hematoma before perforation. Hematoma in medial layer appears as crescent shaped area of high attenuation in the aortic wall.
References: 1. Macura KJ, Corl FM, Fishman EK, Bluemke DA. Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer. AJR 2003;181:309-316.

2. Castaner E, Andreu M, Gallardo X, Mata JM, Cabezuelo MA, Pallardo Y. CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications. Radiographics 2003;23 (Special Issue):S93-S110.
Keywords: Vascular, Vascular, Idiopathic,

대한흉부영상의학회 Korean Society of Thoracic Radiology