Hemothorax as an infrequent complication of aortic dissection in a young patient: a case report

Acute aortic dissection (AAD) is a life-threatening condition with high mortality and a broad spectrum of clinical presentations. Hemothorax is an infrequent but catastrophic complication, particularly uncommon in young patients.

We report the case of a 39-year-old man with treated systemic arterial hypertension and obesity who presented with acute chest pain of approximately 50 minutes duration prior to hospital arrival. The initial clinical presentation was suggestive of acute coronary syndrome, leading to early management in that direction. Non-contrast chest computed tomography (CT) performed approximately 2 hours and 43 minutes after symptom onset revealed a massive left hemothorax, and subsequent contrast-enhanced imaging at approximately 10 hours and 19 minutes confirmed Stanford type B aortic dissection. No point-of-care ultrasound was performed during the initial evaluation. Diagnostic delay and limited access to specialized cardiovascular services contributed to the unfavorable outcome. Despite further diagnostic evaluation, the patient experienced progressive clinical deterioration and developed cardiac arrest approximately 28 hours after initial presentation, resulting in a fatal outcome.

Hemothorax represents a rare but severe manifestation of AAD and should be considered in cases of non-traumatic hemothorax, even in young patients without known genetic disorders. Early recognition, appropriate imaging, and timely referral to specialized centers are critical to improve outcomes.