title: Advanced malignant mesothelioma mimicking acute contained thoracic aortic rupture.
abstract: In the emergent setting, patients presenting with acute interscapular pain along with haemodynamic instability require immediate evaluation. We describe the case of a patient in which computed tomographic scanning demonstrated a large hyper-dense, periaortic collection on post-contrast imaging. Urgent endovascular repair was performed for descending thoracic aortic rupture. Her postoperative course, however, was atypical with a readmission 1 week after discharge with symptoms similar to her primary presentation. Alternative pathologies were then considered in a more elective setting in which the correct diagnosis of diffuse malignant mesothelioma was ultimately discovered in a patient with no previous exposure to occupational toxins. The tumour burden was advanced and the patient opted for palliative care. Herein, we suggest a consideration for oncological thoracic pathology in patients presenting with signs and symptoms mimicking acute thoracic aortic rupture or dissection, who may demonstrate atypical symptoms.
authors.affiliation: Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Mouawad
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Daniel
authors.forename: Jean E
authors.initials: JE
authors.lastname: Starr
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D001019:Aortic Rupture / Q000175:diagnosis*; D001027:Aortography / Q000379:methods; D001706:Biopsy; D019917:Blood Vessel Prosthesis Implantation; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D018450:Disease Progression; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008654:Mesothelioma / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D010166:Palliative Care; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed
keywords: Aortic dissection; Aortic rupture; Malignant mesothelioma