Aortic rupture into the esophagus during angiography

A 67-year-old woman was examined and found to have symptoms and chest roentgenogram suggesting acute aortic dissection. During emergency angiography, massive upper gastrointestinal bleeding developed, and the woman died. The angiogram showed a raised intimal flap of acute dissecting aneurysm. Postmortem examination showed extensive cystic medial necrosis, aortic dilation, and an unusual combination of anatomic abnormalities, which explained the previously unreported false-positive intimal flap. The site of aortic rupture was not localized, but a large tear was found in the esophagus.