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Right Sided Hemothorax Associated with Type B Aortic Dissection Without Rupture: A Case Report and Review of Literature
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A6697 - Right Sided Hemothorax Associated with Type B Aortic Dissection Without Rupture: A Case Report and Review of Literature
Author Block: F. Houshmand1, S. Marco2, V. Maddipati3; 1Pulmonary and critical care, ECU, Brody school of medicine, Greenville, NC, United States, 2Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, NC, United States, 3Dept. Pulmonary and Critical Care, East Carolina University, Greenville, NC, United States.
Development of hemothorax in aortic dissection without rupture is more common with type A and rarely seen in type B dissection. It can be seen on initial presentation or develop in the first few days. Majority of cases present with bilateral pleural effusions and some with right sided pleural effusion. A right-sided pleural effusion is extremely rare in these cases, with only a handful of cases reported thus far. Here we report the tenth case published in English language.
55 year-old male presented with severe tearing chest pain that spread down his torso. Pain started in the morning, and he became pale and diaphoretic. The tearing back pain has been occurring intermittently over the last week. However, his chest pain was new on the day of presentation. He is a former smoker and has a history of uncontrolled hypertension. At the time of presentation Blood pressure was over 300 mm Hg. He was started on nicardipine drip for better blood pressure control and was transferred to our center, where he underwent TEVAR (Thoracic Endovascular Aortic Repair). On POD 2, he was noted to be in respiratory distress and was transferred to critical care unit where he was diagnosed with new right-sided pleural effusion. Diagnostic thoracentesis revealed it to be a hemothorax. which was deemed to be hemothorax after undergoing diagnostic and therapeutic
Initially described by A.K. Detwiller in 1908 on autopsy, right sided hemothorax is a rare occurrence without ruptured aorta in type B aortic dissection, our review of literature reveals only ten prior reported cases of right sided hemothorax without rupture. Most described cases developed from medial tear at level of mid thoracic spine bleeding into posterior mediastinum and crossing the midline to rupture into the right pleural space. Presence of right sided hemothorax, in absence of classic tearing pain, can be the initial presentation of type B aortic dissection without rupture. Given the high mortality when left unrepaired, it is essential for clinicians to be mindful of atypical presentation of type B aortic dissection. Such diagnosis in a timely manner is needed to not only repair AAD, but also to appropriately drain the hemothorax and avoid chronic complications due to presence of blood in thoracic cavity for prolonged period.
Author Block: F. Houshmand1, S. Marco2, V. Maddipati3; 1Pulmonary and critical care, ECU, Brody school of medicine, Greenville, NC, United States, 2Pulmonary and Critical Care Medicine, Vidant Medical Center, Greenville, NC, United States, 3Dept. Pulmonary and Critical Care, East Carolina University, Greenville, NC, United States.
Development of hemothorax in aortic dissection without rupture is more common with type A and rarely seen in type B dissection. It can be seen on initial presentation or develop in the first few days. Majority of cases present with bilateral pleural effusions and some with right sided pleural effusion. A right-sided pleural effusion is extremely rare in these cases, with only a handful of cases reported thus far. Here we report the tenth case published in English language.
55 year-old male presented with severe tearing chest pain that spread down his torso. Pain started in the morning, and he became pale and diaphoretic. The tearing back pain has been occurring intermittently over the last week. However, his chest pain was new on the day of presentation. He is a former smoker and has a history of uncontrolled hypertension. At the time of presentation Blood pressure was over 300 mm Hg. He was started on nicardipine drip for better blood pressure control and was transferred to our center, where he underwent TEVAR (Thoracic Endovascular Aortic Repair). On POD 2, he was noted to be in respiratory distress and was transferred to critical care unit where he was diagnosed with new right-sided pleural effusion. Diagnostic thoracentesis revealed it to be a hemothorax. which was deemed to be hemothorax after undergoing diagnostic and therapeutic
Initially described by A.K. Detwiller in 1908 on autopsy, right sided hemothorax is a rare occurrence without ruptured aorta in type B aortic dissection, our review of literature reveals only ten prior reported cases of right sided hemothorax without rupture. Most described cases developed from medial tear at level of mid thoracic spine bleeding into posterior mediastinum and crossing the midline to rupture into the right pleural space. Presence of right sided hemothorax, in absence of classic tearing pain, can be the initial presentation of type B aortic dissection without rupture. Given the high mortality when left unrepaired, it is essential for clinicians to be mindful of atypical presentation of type B aortic dissection. Such diagnosis in a timely manner is needed to not only repair AAD, but also to appropriately drain the hemothorax and avoid chronic complications due to presence of blood in thoracic cavity for prolonged period.
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