A 79-year-old-man with a ‘niveau’ on a chest radiograph

Abstract

SUMMARYA 79-year-old man was referred to the emergency room following a sudden episode of 'spitting blood', with a blood pressure of 128 (systolic) and 75 mm Hg (diastolic) and a heart rate of 60 bpm. His medical history included the treatment of gastric cancer and untreated hypertension. At that time, his symptoms were limited without any chest, back or abdominal pain. After a presentation of haemoptysis was confirmed, a chest radiograph revealed an air-fluid level (a 'niveau') that was continuous towards the enlarged thoracic aorta and the thoracic cavity. Contrast-enhanced CT was subsequently performed, and revealed an aortic dissection and a pneumothorax adjacent to the dissection, accompanied by blood pooling in the thoracic cavity. The patient died 40 min after the admission to the emergency room due to an additional haemoptysis. The autopsy confirmed the diagnosis of a ruptured aortic dissection with pneumothorax.

Pneumothorax with Ortner syndrome: an unusual presentation of aortic dissection

“…On further literature search, we have found two published case reports regarding type A aortic dissections occurring following tension pneumothorax [3,4] and a case report of aortic dissection associated with pneumothorax [5]. One of the case reports [4] concluded that their patient developed aortic dissection following pneumothorax, because progressive pneumothorax increased intrathoracic pressures to such extent as to cause aortic dissection with an aortic aneurysm.…”