Tension pneumothorax accompanied by type A aortic dissection

Abstract

SummaryA 51-year-old man was brought to the emergency room because of a sudden onset of severe dysponea. On presentation, his blood pressure was 94/55 mm Hg. Oxygen saturation was 86% while he was receiving 10 l/min oxygen through a non-rebreather mask. On physical examination, no jugular venous distention was noted, but breath sounds over the left lung were diminished. A bedside chest radiograph showed left tension pneumothorax, for which urgent needle decompression followed by chest thoracostomy was performed. Ventricular tachycardia developed, but a biphasic shock at 120 J immediately restored normal sinus rhythm. His vital signs, however, did not improve. A CT scan of the chest showed type A aortic dissection with bullae in the upper lobe of the left lung. He had an emergency operation for distal aortic arch displacement and was discharged on the 37th day of hospitalisation. BACKGROUND

Pneumothorax with Ortner syndrome: an unusual presentation of aortic dissection

“…On further literature search, we have found two published case reports regarding type A aortic dissections occurring following tension pneumothorax [3,4] and a case report of aortic dissection associated with pneumothorax [5]. One of the case reports [4] concluded that their patient developed aortic dissection following pneumothorax, because progressive pneumothorax increased intrathoracic pressures to such extent as to cause aortic dissection with an aortic aneurysm.…”

A 79-year-old-man with a ‘niveau’ on a chest radiograph

“…Diaphragmatic hernia and achalasia, where the gastrointestinal tract is the source of both air and fluid, are also common causes of this anomaly 7. Haemothorax due to trauma or followed by spontaneous pneumothorax is another cause of an air-fluid level on a chest radiograph 8 9. In addition, we have encountered cases where air-fluid levels are noted on chest radiographs as a result of malignancy and lung infarction, where cavitary bleeding is observed.…”