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Perforation of the ascending aorta with a hematoma extending into the left-side upper extrapleural cavity

^a Department of Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
^b Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan

*Corresponding author. Tel.: +81-166-68-2494; fax +81-166-68-2499.

E-mail address: tkadoha{at}asahikawa-med.ac.jp (T. Kadohama).

We herein present an extremely rare case of a perforation of the ascending aorta with a hematoma extending into the left-side upper extrapleural cavity. A 62-year-old male with a sudden onset of severe chest pain was referred to our institution because of an abnormal shadow in the left-side upper lung field. Computed tomography revealed a small fusiform aortic arch aneurysm and a hematoma extending to the left-side upper extrapleural cavity. We diagnosed the patient to have acute aortic syndrome and urgent surgery was thus performed. Major bleeding which might be caused by a progression of the perforation was seen during a dissection of the aorta. The aortic arch was transected and a total arch replacement was performed with a 26 mm Dacron graft. No findings of a rupture of the aortic arch aneurysm or dissection were observed. The histopathology of the aorta revealed a severe atheromatous lesion with calcification and thinning disarrayed elastic fibers. The postoperative course was essentially good except for the development of pericardial effusion which required drainage.

Key Words: Acute aortic syndrome; Thoracic aorta; Hemothorax; Penetrating atherosclerotic ulcer