Aortic dissection with chronic haemopericardium

Abstract

drainage the patient's breathing improved and she was discharged home. However, she returned 3 weeks later with increasing shortness of breath. A repeat echocardiogram showed a small pericardial effusion (0.5 cm) and thoracic computed tomography (CT) revealed a dissecting aneurysm of the ascending aorta and aortic arch ( Figure 1). This was judged inoperable and she died 3 days later. J R Soc Med 1999;92:638-639 COMMENT As a complication of aortic dissection, haemorrhage into the pericardial sac with resultant cardiac tamponade is usually sudden and rapidly fatal1. We report a case in which the haemopericardium was chronic rather than acute. CASE HISTORYA previously fit and healthy woman aged 89 years gave a 5-week history of increasing shortness of breath and nonproductive cough without orthopnoea or paroxysmal nocturnal dyspnoea. 3 weeks ago she had had an episode of lower thoracic back pain, resolving over a few days, with poor appetite and some weight loss. On admission she was tachypnoeic with a temperature of 38.3°C. Pulse rate was 90/min, blood pressure 100/60mmHg with 15 mmHg paradox. All peripheral pulses were present and symmetrically equal; she had a pansystolic murmur radiating to the axilla, and on abdominal examination there was smooth 3 cm hepatomegaly. An