Abrupt rupture of an aortic arch aneurysm into the pulmonary artery

Abstract

We report an extremely rare case of pulmonary artery dissection caused by an abrupt rupture of an aortic arch aneurysm into the pulmonary artery. An asymptomatic 80-year-old man was admitted to our hospital for elective surgical repair of aortic arch aneurysm. After admission, sudden onset of hoarseness and dyspnea developed. Echocardiography demonstrated an intimal flap in the pulmonary artery and abnormal shunt flow from aortic arch aneurysm into the pulmonary artery. At surgery, the pulmonary artery dissection involved the main pulmonary artery and both major branches. Total arch replacement and pulmonary artery reconstruction were successfully performed.

Repair of an adult aorto-pulmonary artery fistula associated with a ruptured aortic arch aneurysm using a frozen elephant trunk technique

“…In 1924, Boyd reviewed 4000 autopsy reports of patients with thoracic aortic aneurysms and found 1197 cases of rupture and an APF occurrence rate of 3.7% . Surgical correction of APFs can be performed by direct closure of the orifice and patch repair using the patient's or bovine pericardium and T‐shaped reconstruction of the main PA . Thoracic endovascular aortic repair has also been used to repair aorto‐pulmonary fistulas .…”

Thoracic Saccular Aortic Aneurysm Presenting with Recurrent Laryngeal Nerve Palsy prior to Aneurysm Rupture: A Prodrome of Thoracic Aneurysm Rupture?

“…In case  1, a thoracic aneurysm ruptured 1 month after the advent of hoarseness. Some reports described aneurysms as rupturing 0 to 3 days after the onset of recurrent laryngeal nerve palsy [4–6], whereas aneurysm rupture could be avoided if recurrent laryngeal nerve palsy prompted elective surgery 1 month to 1 year after its onset [4, 7–11]. Chan reported that death occurred after severe chest pain and subsequent hypotension 1 year after manifestation of recurrent laryngeal nerve palsy in a patient with an aneurysm [12].…”

Extensive Bilateral Extraluminal Perivascular Pulmonary Haemorrhage Associated with Stanford Type A Aortic Dissection

“…However, this is exceedingly rare, usually rapidly fatal and occurs most frequently in association with pulmonary hypertension [2]. Pulmonary artery dissections are diagnosed during life in only 14% of cases and are most commonly diagnosed at autopsy.…”