Ruptured thoracic aneurysm presenting as dyspnea and hypotension.
A 65-year-old woman with a two-day history of progressive back pain presented with acute dyspnea, tachypnea, hypotension, and tachycardia. The patient was being treated for chronic obstructive lung disease and long-standing hypertension. She evidenced unilateral diminished breath sounds and wheezing. A portable chest radiograph in the emergency department revealed a large left pleural effusion. A hemothorax was confirmed by thoracentesis, and a 7-cm descending thoracic aortic aneurysm was demonstrated by angiography. The patient underwent successful surgical resection and Dacron graft repair of the aneurysm. This case emphasizes the need for maintaining a high index of suspicion for atypical presentations of ruptured thoracic aneurysms and for using diagnostic thoracentesis in pleural effusions of unknown etiology.
Sheets
C A
CA
Department of Emergency Medicine, Wright State University School of Medicine, Dayton, Ohio 45401.
Janz
T G
TG
D000368:Aged; D001013:Aorta, Thoracic; D001019:Aortic Rupture / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D001807:Blood Vessel Prosthesis; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D011859:Radiography