Spontaneous nontraumatic rupture of the thoracic aorta

Penetrating aortic ulcer: Clinical and angiographic characteristics

“…Angiograpic images of focal intimal disruption have been described in cases of spontaneous ruptures of the aorta [9,10] and some authors suggest that subtle intimal abnormalities should not be overlooked in the aortography of patients with acute chest and/or back pain [9,10]. Stanson et al [I] used for the first time the term "penetrating aortic ulcer" to describe an intimal abnormality with an angiographic appearance similar to peptic ulcer seen in the stomach on barium examination.…”

Spontaneous Rupture of the Thoracic Aorta

“…Although rupture of an existing abdominal aneurysm is relatively common 9,10 and that of the thoracic aorta not rare, 1,4 de novo rupture of the aorta is quite unusual. An extensive literature review found reports of only seven cases of spontaneous rupture of the thoracic aorta 8,11‐15 . An eighth reported case actually was preceded by blunt trauma 16 .…”

“…No details were reported in two of the seven cases of spontaneous thoracic rupture 8 . The remaining five 11–15 were aged 50 to 64; all were hypertensive, and four of the five were men. Three had hemoptysis during their illness, and four died of their illness, all having been hospitalized at least 12 days.…”

“…Two of these four presented with a cough and vague neck or back pain and the other two with abdominal pain (one with hematemesis). The only patient to survive presented with typical sudden onset of severe “tearing” interscapular pain and was operated on the day of admission 15 …”

“…Spontaneous rupture of the thoracic aorta is uniformly fatal without surgery. Of the cases reviewed, only the one receiving prompt surgery survived 15 . In the two cases of steroid‐associated rupture, both had surgery with one surviving 17 .…”