Penetrating atherosclerotic aortic ulcer rupture causing a right hemothorax; a rare presentation of acute aortic syndrome

Abstract

Acute aortic syndrome is a spectrum of diseases that have similar presentation and clinical background and include aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. Presented here is an 82-year-old woman with a medical history of diabetes, hypertension, nephrectomy, and chronic renal failure who complained of sudden abdominal pain radiating to epigastrium and back. At presentation, the patient was hemodynamically stable with a hemoglobin level of 10.2 and white blood cell count of 12. Chest x-ray showed a right pleural effusion and lung opacity with interstitial pulmonary edema. Computed tomography demonstrated an aortic penetrating atherosclerotic ulcer that ruptured into the right pleural space resulting in right hemothorax. A percutaneous endostent was placed with subsequent discharge of the patient 10 days after admission.