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Updated: Sep 16, 2025

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A Quiet Rupture: Hemodynamically Stable Ruptured Descending Thoracic Aortic Aneurysm Presenting as Lower Respiratory

Rohan Krishna N K1, Anupama R S2, Lekhana Dayanand3

  • 1Emergency Medicine, Fortis International Hospital, Rajajinagar, Bengaluru, IND.

Cureus
|July 7, 2025
PubMed
Summary

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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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A pneumothorax is a condition where air builds up in the space between the lung and the chest wall, causing the lung to collapse. This condition arises when air enters the space between the parietal and visceral pleura, disrupting the negative pressure essential for lung inflation. This can lead to a partial or complete collapse of the lung.
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
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Aortic Regurgitation I: Introduction01:15

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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
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Aneurysm III: Interprofessional Care01:26

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Acute Respiratory Failure-IV01:23

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Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...
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Ruptured descending thoracic aortic aneurysm (DTAA) can mimic respiratory illness, delaying diagnosis. Early computed tomography angiography (CTA) is crucial for identifying DTAA, even in stable patients with unexplained pleural effusions.

Area of Science:

  • Vascular Surgery
  • Thoracic Surgery
  • Diagnostic Imaging

Background:

  • Descending thoracic aortic aneurysm (DTAA) rupture is a rare vascular emergency.
  • Atypical presentations can mimic respiratory infections, leading to diagnostic delays.

Observation:

  • A 63-year-old male with chest pain initially diagnosed as unstable angina.
  • Symptoms progressed to cough, fever, and pleuritic pain, suggesting a lower respiratory tract infection.
  • Imaging revealed a contained DTAA rupture with hemothorax.

Findings:

  • High-resolution computed tomography (HRCT) identified a partially thrombosed DTAA.
  • Computed tomography angiography (CTA) confirmed the rupture into the pleural space.
  • Thoracic endovascular aortic repair (TEVAR) successfully excluded the aneurysm.
Keywords:
aortic emergencycontained aortic rupturect angiographydescending thoracic aortic aneurysmdiagnostic delayhemothoraxhigh-resolution ctlower respiratory tract infection mimicmisdiagnosistevar

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Implications:

  • This case highlights the diagnostic challenges of atypical DTAA.
  • Emphasizes the importance of early CTA for unexplained pleural effusions.
  • Underscores the need for structured post-TEVAR surveillance for long-term outcomes.