Asian Cardiovasc Thorac Ann 2006;14:441-442
© 2006 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Aortic Pseudoaneurysm Rupture into the Oesophagus
Charalambos Zisis, PhD,
Dimitrios Exarchos, PhD1,
Konstantinos Kotsifas, MD2,
Mihalis Argiriou, MD,
Athanassios Portinos, MD,
Ion Bellenis, PhD
Department of Cardiothoracic and Vascular Surgery
1 Department of Computed Tomography
2 Department of Chest Medicine and Respiratory Diseases, Evangelismos General Hospital Athens, Greece
For reprint information contact: Charalambos Zisis, PhD Tel: 30 69 4587 5222 Fax: 30 21 0722 4449 Email: chzisis{at}otenet.gr, 17a, Patriarchou Grigoriou str, Glyfada 166 74, Greece.
A 75-year-old female was addressed in our hospital emergencies in a hypovolemic state after massive hematemesis. For the previous 4 days, the patient had been hospitalized in another hospital, where hemoptysis and pulmonary infiltrates of the right lower lobe were recorded as the patient main findings. Twelve hours before her arrival in our hospital, her condition had been seriously aggravated. The diagnostic work-up revealed oesophageal dilation with air-fluid level (Figure 1
), due to a communication of the oesophageal lumen with a pseudoaneurysm of the diaphragmatic aorta (Figure 2). The angiographic evaluation confirmed the pseudoaneurysm (Figure 3).
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Figure 1. Dilation of the esophageal lumen with air-fluid level; passive atelectasis and infiltration of the right lower lobe potentially due to presence of aspiration.
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Figure 2. Rupture of the aortic pseudoaneurysm into the oesophagus at the level of the diaphragm; extravasation of the contrast material from the aorta into the oesophageal lumen.
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She underwent a left thoracoabdominal incision. The left lung had adhesions with the descending aorta and the aneurysm, while diffuse hemorrhage spread. Inflammation was evident in the macroscopic appearance of the lung and all surrounding tissues. The patient died at the phase of surgical manipulations on the pseudoaneurysm, due to continuing hemorrhage and hypovolemia.
