Aortic hammer syndrome

To present a case of penetrating aortic ulcer with extraordinary etiology.

A 57-year-old man was admitted with acute retrosternal and interscapular pain. He was a demolition worker and often used a pneumatic drill to which he pressed his chest as he drilled. Clinical examination showed previously undiagnosed hypertension. Computed tomographic angiography disclosed a penetrating aortic ulcer in the descending thoracic aorta without any sign of atherosclerosis. Initial treatment consisted of blood pressure control. However, due to progression of the lesion, endovascular treatment was performed to implant a covered endoprosthesis.

We hypothesize that the etiology of the ulcer was the shear forces developed by incorrect, repetitive use of the pneumatic hammer in combination with the untreated hypertension. This is analogous to the hypothenar hammer syndrome, and we propose naming this the "aortic hammer syndrome."