Presentation
Chest pain radiating to the back.
Patient Data
Small tear in the left wall of the thoracic aorta at the level of T8, with a large hematoma in the posterior mediastinum compressing the left atrium, continuing caudally into the abdomen through the diaphragmatic esophageal hiatus, mostly contained within the lesser sac and the superior part of the left prerenal fascia. Small amount of free intraperitoneal bloody fluid in the pelvis.
The aorta shows soft plaque with irregular borders beginning at the level of the aortic arch peak. The descending aorta is ectatic and convoluted, with nonocclusive mural thrombus. The thoracic aorta is dilated up to a diameter of 55 mm. The infrarenal aorta shows an irregular external border, probably due to evacuation of massive peripheral plaque seen in the previous study (not shown). Patent aortobifemoral bypass.
Status post segmentectomy in the right lung.
Mass with irregular borders measuring 22 x 16 x 16 mm in right upper lobe (RUL) at the medial border of the staple line - has enlarged substantially.
Very small left pleural effusion (not hemothorax).
Bilateral subscapular elastofibroma dorsi.
Tiny left adrenal adenoma.
Small bowel anastomosis to the right of the umbilicus.
Chest x-ray done 2 months later shows that a stent graft was placed in the thoracic aorta.
Case Discussion
She underwent endovascular repair with a thoracic stent graft, placed between the origin of the left subclavian artery (LSA) and the origin of the celiac trunk.
Further investigation of the right lung mass confirmed recurrence of squamous cell carcinoma.
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