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Eur J Cardiothorac Surg 2004;26:829
© 2004 Elsevier Science NL

Images in cardio-thoracic surgery

A rare case of intimal rupture of the ascending aortic wall

D. Mangino*, R. Moretti, E. Polesel, C. Zussa

Department of Cardiac Surgery, "Umberto I°" Hospital, Venezia-Mestre, Italy

Received 26 March 2004; received in revised form 20 May 2004; accepted 21 May 2004.

* Corresponding author. Address: Cardiochirurgia Ospedale Venezia-Mestre, via Circonvallazione, 50 30174 Venezia-Mestre, Italy. Tel.: +39-041-2608332; fax: +39-041-2608340
e-mail: domenicomangino{at}libero.it

Key Words: Pericardium • Aorta • Aortic haematoma • Vascular thoracic

A 58-year-old man presented cardiac tamponade. TEE and CT-scan revealed pericardial effusion and absence of aortic intimal flap. (Fig. 1)



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  		Fig. 1. CT-scan: pericardial effusion with no signs of intimal flap.

 
At operation there was an eccentric ascending aorta bulge. The aorta opening reveals an intimal rupture (Fig. 2) without flap.



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  		Fig. 2. Intraoperative view: intimal rupture.

 
This kind of lesion, with lack a mobile intimal flap, is difficult to identify by TEE or CT-scan and easily evolves in an aortic dissection.





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