Pseudohemothorax induced by residual contrast medium mimicking aortic dissection rupture

Hemothorax is an urgent condition, and its accurate diagnosis and the identification of the cause are important. Herein, we report a case of a 74-year-old man with end-stage renal disease who was presented with high-concentration pleural effusion owing to residual contrast medium. The case required differentiation from hemothorax owing to an aortic dissection and its rupture. In patients with end-stage renal disease, noncontrast-enhanced computed tomography after contrast-enhanced computed tomography may result in high-concentration pleural effusion owing to the existence of residual contrast medium. This realization is important to determine whether high-concentration pleural effusion symptoms reflect an urgent hemothorax case possibly related to an imminent rupture of an aortic aneurysm or intrathoracic penetration of aortic dissection, and whether invasive procedures, such as thoracentesis, ought to be avoided.