title: Perforation of the ascending aorta with a hematoma extending into the left-side upper extrapleural cavity.
abstract: 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.
authors: Department of Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan. tkadoha@asahikawa-med.ac.jp
authors: Takayuki
authors: T
authors: Kadohama
authors: Nobuyuki
authors: N
authors: Akasaka
authors: Kazutomo
authors: K
authors: Goh
authors: Tadahiro
authors: T
authors: Sasajima
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D001019:Aortic Rupture / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D003937:Diagnosis, Differential; D004322:Drainage; D004638:Emergency Treatment; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006470:Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology / Q000601:surgery; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D013902:Radiography, Thoracic; D013577:Syndrome; D035423:Thoracic Cavity / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery
chemical_list: D011093:Polyethylene Terephthalates