Should patients with contained rupture of a descending aortic aneurysm only receive unilateral artificial ventilation? Case report of a death during an operation.
The danger of thoracic aneurysm rupture increases with the size of the aneurysm. We report on a 59-year-old man who developed a secondary aneurysm of the descending thoracic aorta within the residual type A dissection that was approximately 9-cm long and in which a contained rupture occurred. The patient died as a result of a massive hemorrhage during the anesthesiological preparation for emergency operation a short time after double-lumen intubation and commencement of controlled artificial ventilation. Autopsy revealed an atelectatic lower pulmonary lobe that had partially fused with the aneurysm. The fusion may have been so substantial that it may have acutely eliminated the covering of the contained rupture during artificial ventilation.
Hofmann
Hans-Stefan
HS
Department of Cardiothoracic Surgery, Martin Luther University, Halle-Wittenberg, Halle, Germany. stefan.hofmann@medizin.uni-halle.de
Kroll
Heike
H
Kunze
Christian
C
Bromber
Harry
H
D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001344:Autopsy; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed