PMC8358570_01
(a) CT reveals the extravasation of contrast media from the ascending aorta (yellow arrow) that created a large hematoma in the anterior mediastinum and right hemothorax. (b) The bleeding point (white arrow), located at the distal ascending aorta, is surrounded by multiple calcium plaques (black arrowheads).
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Echocardiography revealed a moderate amount of pericardial effusion, while contrast-enhanced computed tomography (CT) revealed extravasation of contrast media from the distal ascending aorta; this created a massive hematoma in the anterior mediastinum and right hemothorax (Figure 1(a)). The bleeding point was surrounded by multiple calcified plaques (Figure 1(b)).
(a) Intraoperative view. Blood (white arrowhead) is leaking from a wound (arrow) on the distal ascending aorta. There is a small laceration around the wound (yellow arrowhead). (b) The wound is directly closed with 3-0 sutures and felt strips.
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Upon coagulation removal, blood spurted from a 2-mm hole located on the anterior wall of the distal ascending aorta (Figure 2(a)). We closed the pinhole directly with 3-0 interrupted sutures and Teflon felt strips (Figure 2(b)).
Epiaortic echocardiography demonstrates intimal ulceration (arrow) with subsequent penetration into the media and adventitia. However, neither aortic dissection nor intramural hematoma was observed adjacent to the ulcer.
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Epiaortic echocardiography revealed a PAU (4 mm in diameter), with subsequent penetration into the media and adventitia, which resulted in a frank rupture of the aorta (Figure 3).