Radiology Case of the Month

Lorna Breen

Dr. Lorna Breen
Medical Director, Allen Hospital ED


This 45 year old female was brought into the ED by EMS after a bystander called for patient down on sidewalk. Patient had recent sternotomy for unclear reasons and complained of back pain.

Question 1: What is the structure indicated by the arrow below?

This is an aortic graft. The patient had had a recent endovascular aortic arch graft repair at an outside hospital.

Question 2: Based on the image below, what do you think is her diagnosis?

The patient had an extensive aortic dissection (see arrow below) with rupture of the false lumen.

For extra credit, why does the fluid have two densities and what is the name for this finding?

The two densities are most likely pleural fluid (due to recent chest surgery) and blood (due to rupture of the false lumen.) The name for this is hydrohemothrorax.

In the ED, the patient had a positive bedside ultrasound for fluid in the left thorax, a hbg of 5.7 and was hypotensive and tachycardic.  Because she was on Coumadin, she received KCentra and Vitamin K as well as blood products. After she was more stable, she underwent surgical aortic repair and was discharged home in stable condition about a month later.