Ruptured thoracic aortic aneurysm presenting as massive epistaxis; report of a case

An 80-year-old woman was transported to the emergency room at our hospital by the ambulance, suffering from massive epistaxis. As the patient was hemodynamically stable, otolaryngologist attempted to perform tamponade using nasal packing. However, the patient's condition deteriorated, with the development of dyspnea and a reduction in oxygen saturation to 90%. A chest X-ray performed at this point revealed left lung consolidation and pleural effusion while chest computed tomography (CT) demonstrated that rupture of a descending aortic aneurysm with periaortic hematoma and extension of hemorrhage into the left lower lobe of the lung. Emergency surgery was performed under partial extracorporeal circulation, established by cannulation of the right femoral artery and vein. In addition to the replacement of the descending aorta with a prosthetic conduit, left lower lobectomy was necessary because of severe adhesion to the descending aorta. The postoperative course was largely uncomplicated apart from development of chylothorax, which resolved with a short period of total parenteral nutrition and she was discharged 50 days after surgery.