Spontaneous mediastinal hemorrhage associated with renovascular hypertension

We report on a patient with severe renovascular hypertension associated with massive spontaneous mediastinal hemorrhage. Differentiation of this entity from aortic dissection, as well as establishing the cause of the severe hypertension, was possible only through the aid of angiography. Following exploratory thoracotomy, renal artery revascularization was carried out, with resolution of the hypertension. To our knowledge, this complication of renovascular hypertension has not been reported. Prompt recognition and appropriate therapy were possible only after angiographic evaluation.