Mohammed Azfar SIDDIQUI, Jamal AKHTAR, Syed Wajahat Ali RIZVI, Syed Amjad Ali RIZVI, Ibne AHMAD, Ekramullah

Painless left hemorrhagic pleural effusion: An unusual presentation of leaking saccular aortic arch aneurysm

Torasik aort anevrizmalarının çoğu asemptomatik olup, diğer nedenlerle çekilen rutin göğüs radyografilerinde tesadüfensaptanırlar. Sadece, nadir olarak, sıklıkla ciddi ağrı ile başvuruya neden olan hayatı tehdit eden kaçak ve diseksiyon var-lığında semptomatik olurlar. Bu yazıda, nefes darlığı, aralıklı öksürük, ateş ve sol taraflı ağrısız hemorajik plevral efüzyon-lu 67 yaşında bir erkek olguyu sunuyoruz. Radyografi, bilgisayarlı tomografi ve manyetik rezonans görüntüleme ile arkusaorta transvers bölümü lateralinden yükselen bir sakküler anevrizma ve sol plevral boşlukla ilişkili, yalancı lümenli disse-ke desendan aort anevrizması saptandı. Olgu, cerrahi tedaviyi kabul etmedi ve kan transfüzyonu ve antihipertansif medi-kasyon ile konservatif olarak tedavi edildi. Sekizinci günde, fatal şok epizodu nedeniyle kaybedildi. Klinik olarak bronşkarsinomunu düşündüren, nefes darlığı, öksürük ve ateşle başvuran nontravmatik hemorajik plevral efüzyonlu yaşlı has-talarda ayırıcı tanıda disekan torasik anevrizmanın yer almasını düşünüyoruz. Tanısal işlem olarak toraks bilgisayarlı to-mografisi acilen çekilmelidir.

Ağrısız sol hemorajik plevral efüzyon: Sakküler arkus aorta anevrizma kaçağının nadir bir prezantasyonu

Most thoracic aortic aneurysms are asymptomatic and are detected by chance on routine chest imaging for some other re-asons. Only rarely it is symptomatic due to leak and dissection which is a potentially life threatening event that commonlypresents with severe pain. In this report, we present the case of a 67-year-old man who presented with shortness of breath,intermittent cough, fever, and left sided painless hemorrhagic pleural effusion. Further investigation by plain radiography,computed tomography and magnetic resonance imaging revealed a saccular aneurysm arising from the lateral aspect of themid-transverse arch of the aorta, along with a dissecting descending aortic aneurysm with false lumen communicating withleft pleural space. The patient refused any surgical procedure and was treated conservatively with blood transfusions andanti hypertensive medication. On the 8th day patient finally succumb to a fatal episode of shock. We suggest dissecting tho-racic aneurysm be included in the differential diagnosis of non-traumatic hemorrhagic pleural effusion in an elderly patientpresenting with dysnea, cough and fever, which otherwise suggest the clinical diagnosis of bronchogenic carcinoma. Com-puted tomography of the chest should be immediately performed as the diagnostic procedure of choice.

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