PMC4222319_01
Chest radiography on admission revealing a normal cardio-thoracic ratio of 47%. There is no evidence of cardiomegaly, pulmonary congestion, or the retention of pleural effusion (A). On admission, echocardiography revealed fluid retention in the pericardium of anterior and posterior walls of left ventricular. Ejection fraction was preserved with 55% (B).
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A chest radiograph revealed a normal cardio-thoracic ratio of 47%; moreover, there was no evidence of cardiomegaly, pulmonary congestion, or pleural effusion (Fig. 1A). A transthoracic echocardiogram revealed evidence of fluid retention in the pericardium of the anterior and posterior walls of the left ventricle, as well as a preserved ejection fraction of 55% (Fig. 1B).
On day 3, chest radiography revealed enlargement of the cardiac shadow (cardio-thoracic ratio of 58%) and the protrusion of the left first arch (A). On day 3, contrast-enhanced chest computed tomography revealed an ulcer-like projection along the lesser curvature of the aortic arch surrounded by a hematoma. At this point, a ruptured thoracic aortic aneurysm was suspected (B). Coronal view enhanced computed tomography revealed pericardial effusion (C).
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On day 3, a chest radiograph revealed enlargement of the cardiac shadow (cardio-thoracic ratio of 58%) and the protrusion of left first arch (Fig. 2A). CT revealed an ulcer-like projection along the lesser curvature of the aortic arch surrounded by a hematoma (Fig. 2B and C).
Surgical findings. The thoracic aortic aneurysm with infection was exposed (A). The aneurysm was resected and the rifampicin-soaked prosthetic graft was placed (B). Surgical findings of the scheme revealed a saccular aortic aneurysm with calcification at the aortic arch (C). A rifampicin-soaked prosthetic graft was placed and the omentum was packed into the aortic aneurysm and around the circumference of the prosthetic graft (D).
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Surgery (Fig. 3A-D) was performed under general anesthesia.