case_images: PMC8358570_01
case_images: (a) CT reveals the extravasation of contrast media from the ascending aorta (yellow arrow) that created a large hematoma in the anterior mediastinum and right hemothorax. (b) The bleeding point (white arrow), located at the distal ascending aorta, is surrounded by multiple calcium plaques (black arrowheads).
case_images: 10.1177_2050313X211037784-fig1.jpg
case_images: PMC8358570_01_10.1177_2050313X211037784-fig1.jpg
case_images: fig1-2050313X211037784
case_images: Echocardiography revealed a moderate amount of pericardial effusion, while contrast-enhanced computed tomography (CT) revealed extravasation of contrast media from the distal ascending aorta; this created a massive hematoma in the anterior mediastinum and right hemothorax (Figure 1(a)). The bleeding point was surrounded by multiple calcified plaques (Figure 1(b)).
case_images: (a) Intraoperative view. Blood (white arrowhead) is leaking from a wound (arrow) on the distal ascending aorta. There is a small laceration around the wound (yellow arrowhead). (b) The wound is directly closed with 3-0 sutures and felt strips.
case_images: 10.1177_2050313X211037784-fig2.jpg
case_images: PMC8358570_01_10.1177_2050313X211037784-fig2.jpg
case_images: fig2-2050313X211037784
case_images: Upon coagulation removal, blood spurted from a 2-mm hole located on the anterior wall of the distal ascending aorta (Figure 2(a)). We closed the pinhole directly with 3-0 interrupted sutures and Teflon felt strips (Figure 2(b)).
case_images: Epiaortic echocardiography demonstrates intimal ulceration (arrow) with subsequent penetration into the media and adventitia. However, neither aortic dissection nor intramural hematoma was observed adjacent to the ulcer.
case_images: 10.1177_2050313X211037784-fig3.jpg
case_images: PMC8358570_01_10.1177_2050313X211037784-fig3.jpg
case_images: fig3-2050313X211037784
case_images: Epiaortic echocardiography revealed a PAU (4 mm in diameter), with subsequent penetration into the media and adventitia, which resulted in a frank rupture of the aorta (Figure 3).