Non-recognized cause of intrathoracic bleeding

The authors present a case report of bleeding from the small dissection of descending aorta. Patient, 71 year old woman, with severe comorbidities (nephrotic syndrome based on membraneous glomerulonephritis, diabetes mellitus, lung emphysema, hepatopathy, polyneuropathy and others). One month after last stay in hospital chemotherapy et corticotherapy. In while on heparin during hospitalization at nephrologic department, patient developed right side haemothorax and haemomediastinum. An urgent transfer to surgical department with cardiopulmonary resuscitation was performed. The suspection of aneurysm on CT angioscan was non confirmed. The damage of oesophagus due to previous endoscopy (for chest pain) was non confirmed, too. During surgery masive sanquine effusion of mediastinum and right side haemothorax was found. The drainage and redrainage of the chest was performed. The cause of bleeding was not found. Critically ill patient had died and on autopsy a small dissection of thoracic aorta was found as a cause of bleeding. The problems of diagnosis and therapy are discussed. (Fig. 2, Ref. 7.)