A Case of Left Haemothorax from Contained Rupture of Penetrating Atherosclerotic Ulcer

Authors

  • Yen Ming Chan Vascular Surgery Department, Aberdeen Royal Infirmary Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, United Kingdom
  • James Matossian
  • Bryce Renwick

DOI:

https://doi.org/10.53555/hsn.v4i2.258

Keywords:

Penetrating Atherosclerotic Ulcer, Acute Aortic Syndrom, TEVAR

Abstract

Penetrating Atherosclerotic Ulcer (PAU) is a rare clinical entity of Acute Aortic Syndrome (AAS). The rupture rate for PAU is almost ten-times that of aortic dissection but the clinical diagnosis of this condition can be challenging due to numerous other condition presenting with similar symptoms of “aortic pain”. However, with a unique prognosis, treatment strategy is distinct and prompt diagnosis with early specialist input is needed. We report a case of PAU presenting with collapse, chest and abdominal pain with a left Haemothorax.  

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Author Biographies

James Matossian

Foundation Year 2 doctor

Bryce Renwick

Consultant Vascular Surgeon

References

Ahmad, F., Cheshire, N., & Hamady, M. (2006). Acute aortic syndrome: pathology and therapeutic strategies. Postgraduate Medical Journal, 82(967), 305 LP-312. Retrieved from http://pmj.bmj.com/content/82/967/305.abstract

Ando, Y., Minami, H., Muramoto, H., Narita, M., & Sakai, S. (1994). Rupture of thoracic aorta caused by penetrating aortic ulcer. Chest, 106(2), 624–626. https://doi.org/10.1378/chest.106.2.624

Brittenden, J., McBride, K., McInnes, G., Gillespie, I. N., & Bradbury, A. W. (1999). The use of endovascular stents in the treatment of penetrating ulcers of the thoracic aorta. Journal of Vascular Surgery, 30(5), 946–949. https://doi.org/10.1016/S0741-5214(99)70021-2

Cho, K. R., Stanson, A. W., Potter, D. D., Cherry, K. J., Schaff, H. V, & Sundt, T. M. (2004). Penetrating atherosclerotic ulcer of the descending thoracic aorta and arch. The Journal of Thoracic and Cardiovascular Surgery, 127(5), 1393–1401. https://doi.org/10.1016/j.jtcvs.2003.11.050

Chou, A. S., Ziganshin, B. A., Charilaou, P., Tranquilli, M., Rizzo, J. A., & Elefteriades, J. A. (2016). Long-term behavior of aortic intramural hematomas and penetrating ulcers. The Journal of Thoracic and Cardiovascular Surgery, 151(2), 361–373.e1. https://doi.org/10.1016/J.JTCVS.2015.09.012

Coady, M. A., Ikonomidis, J. S., Cheung, A. T., Matsumoto, A. H., Dake, M. D., Chaikof, E. L., Sellke, F. W. (2010). Surgical Management of Descending Thoracic Aortic Disease: Open and Endovascular Approaches. Circulation, 121(25), 2780 LP-2804. Retrieved from http://circ.ahajournals.org/content/121/25/2780.abstract

Coady, M. A., Rizzo, J. A., Hammond, G. L., Pierce, J. G., Kopf, G. S., Elefteriades, J. A., & Donaldson, M. C. (1998). Penetrating ulcer of the thoracic aorta: What is it? How do we recognize it? How do we manage it? Journal of Vascular Surgery, 27(6), 1006–1016. https://doi.org/10.1016/S0741-5214(98)70003-5

Committee, W., Riambau, V., Bockler, D., Brunkwall, J., Cao, P., Chiesa, R., Schmidli, J. (2017). Editor’s Choice -Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery : The Official Journal of the European Society for Vascular Surgery, 53(1), 4–52. https://doi.org/10.1016/j.ejvs.2016.06.005

D’Annoville, T., Ozdemir, B.A., Alric, P., Marty-Ané, C. H., & Canaud, L. (2016). Thoracic Endovascular Aortic Repair for Penetrating Aortic Ulcer: Literature Review. The Annals of Thoracic Surgery, 101(6), 2272–8. https://doi.org/10.1016/j.athoracsur.2015.12.036

Dalio, M. B., Dezotti, N. R. A., Ribeiro, M. S., Joviliano, E. E., & Piccinato, C. E. (2015). Aortogastric Fistula Due to a Penetrating Atherosclerotic Aortic Ulcer. Annals of Vascular Surgery, 29(8), 1659.e21-1659.e25. https://doi.org/10.1016/j.avsg.2015.06.080

Ganaha, F., Miller, D. C., Sugimoto, K., Do, Y. S., Minamiguchi, H., Saito, H., ... Dake, M. D. (2002). Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: A clinical and radiological analysis. Circulation, 106(3), 342–348. https://doi.org/10.1161/01.CIR.0000022164.26075.5A

Gifford, S. M., Duncan, A. A., Greiten, L. E., Gloviczki, P., Oderich, G. S., Kalra, M., ... Bower,

T. C. (2016). The natural history and outcomes for thoracic and abdominal penetrating aortic ulcers. Journal of Vascular Surgery, 63(5), 1182–1188. https://doi.org/10.1016/j.jvs.2015.11.050

Harris, J. A., Bis, K. G., Glover, J. L., Bendick, P. J., Shetty, A., & Brown, O. W. (1994). Penetrating atherosclerotic ulcers of the aorta. Journal of Vascular Surgery, 19(1), 90–99. https://doi.org/10.1016/S0741-5214(94)70124-5

Hiratzka, L. F., Bakris, G. L., Beckman, J. A., Bersin, R. M., Carr, V. F., Casey, D. E., ... Williams, D. M. (2010). 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2010.02.015

Kazerooni, E. A., Bree, R. L., & Williams, D. M. (1992). Penetrating atherosclerotic ulcers of the descending thoracic aorta: evaluation with CT and distinction from aortic dissection. Radiology, 183(3), 759–65. https://doi.org/10.1148/radiology.183.3.1584933

Kyaw, H., Sadiq, S., Chowdhury, A., Gholamrezaee, R., & Yoe, L. (2016). An uncommon cause of chest pain –penetrating atherosclerotic aortic ulcer. Journal of Community Hospital Internal Medicine Perspectives, 6(3), 10.3402/jchimp.v6.31506. https://doi.org/10.3402/jchimp.v6.31506

Nathan, D. P., Boonn, W., Lai, E., Wang, G. J., Desai, N., Woo, E. Y., Jackson, B. M. (2012). Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease. Journal of Vascular Surgery, 55(1), 10–15. https://doi.org/10.1016/j.jvs.2011.08.005

Patatas, K., Shrivastava, V., & Ettles, D. F. (2013). Penetrating atherosclerotic ulcer of the aorta: A continuing debate. Clinical Radiology, 68(8), 753–759. https://doi.org/10.1016/j.crad.2012.11.014

Samal, A. K., White, C. J., & Kot, J. B. (2001). Penetrating atherosclerotic ulcer of the aorta. Journal of Endovascular Therapy : An Official Journal of the International Society of Endovascular Specialists, 8(5), 534–538. https://doi.org/10.1177/152660280100800517

Siegel, Y. (2013). Penetrating atherosclerotic aortic ulcer rupture causing a right hemothorax; a rare presentation of acute aortic syndrome. The American Journal of Emergency Medicine, 31(4), 755.e5-755.e7. https://doi.org/10.1016/j.ajem.2012.11.009

Soyama, A., Kono, T., Matsuoka, T., Otsuka, K., Murakami, S., Tsuji, H., Minakata, K. (2015). A Case of Penetrating Atherosclerotic Ulcer Treated With Thoracic Endovascular Aortic Repair. Circulation, 132(24), 2352 LP-2353. Retrieved from http://circ.ahajournals.org/content/132/24/2352.abstract

Stanson, A. W., Kazmier, F. J., Hollier, L. H., Edwards, W. D., Pairolero, P. C., Sheedy, P. F., ... Johnson, M. C. (1986). Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations. Annals of Vascular Surgery, 1(1), 15–23. https://doi.org/10.1007/BF02732450

Tittle, S. L., Lynch, R. J., Cole, P. E., Singh, H. S., Rizzo, J. A., Kopf, G. S., & Elefteriades, J. A. (2002). Midterm follow-up of penetrating ulcer and intramural hematoma of the aorta. The Journal of Thoracic and Cardiovascular Surgery, 123(6), 1051–9. https://doi.org/10.1067/MTC.2002.121681

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Published

2018-02-28

How to Cite

Chan, Y. M., Matossian, J., & Renwick, B. (2018). A Case of Left Haemothorax from Contained Rupture of Penetrating Atherosclerotic Ulcer. International Journal For Research In Health Sciences And Nursing, 4(2), 25–39. https://doi.org/10.53555/hsn.v4i2.258