Fatal retropleural hematoma from a ruptured abdominal aortic pseudo-aneurysm

This paper has reported a case of sudden unexpected death in a 19-year-old man, shot in the abdomen, who was surgically treated and discharged. He died of massive left retropleural hematoma from a spontaneous rupture of a traumatic pseudo-aneurysm of the abdominal aorta. Diagnosis of the retropleural hemorrhage and the aortic pseudo-aneurysm was possible, though not made antemortem, through chest X-rays and ultrasound studies of the abdomen correlated with the patient's symptoms. Early radiologic signs of the hematoma consisted of obliteration of the aortic silhouette on the anteroposterior view and the left primary sulcus on the lateral film by a convex expanding homogenous density whose medial border blended imperceptibly with the mediastinal shadow. On ultrasound study the pseudo-aneurysm appears as semilucent midline shadow anterior to the vertebral column and related to the aorta, giving the latter an appearance of increased diameter.