title: A case of an upper gastrointestinal bleeding due to a ruptured dissection of a right aortic arch.
abstract: We report a case of severe upper gastrointestinal hemorrhage with a rare underlying cause. The patient was unconscious when he was admitted to the hospital. No chest radiogram was performed. Routine diagnostic measures, including endoscopy, failed to reveal the origin of the bleeding, which was believed to originate from the esophagus secondary to a peptic ulcer or varices. Exploratory laparotomy added no further information, but contrast-enhanced multislice computed tomography (MSCT) of the chest showed dextroposition of the widened aortic arch with a ruptured type-B dissection and a consecutive aorto-esophageal fistula (AEF). The patient died on the day of admission. Noninvasive MSCT angiography gives rapid diagnostic information on patients with occult upper gastrointestinal bleeding and should be considered before more invasive conventional angiography or surgery.
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, D-80336 Munich, Germany. christine.born@ikra.med.uni-muenchen.de
authors.forename: Christine
authors.initials: C
authors.lastname: Born
authors.forename: Andreas
authors.initials: A
authors.lastname: Forster
authors.forename: Clemens
authors.initials: C
authors.lastname: Rock
authors.forename: Klaus-Jürgen
authors.initials: KJ
authors.lastname: Pfeifer
authors.forename: Johannes
authors.initials: J
authors.lastname: Rieger
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
mesh_terms: D000784:Aortic Dissection / Q000150:complications*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications*; D001019:Aortic Rupture / Q000150:complications*; D004937:Esophageal Fistula / Q000209:etiology*; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography