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J Thorac Cardiovasc Surg 2007;134:1040-1041
© 2007 The American Association for Thoracic Surgery

Brief Communication

Should large mediastinal hematomas be drained after endovascular repair of ruptured descending thoracic aorta?

Said Yassin, MD*, John Marek, MD, Jess Schwartz, MD, Jorge Wernly, MD, Charles Dietl, MD, Stuart Pett, MD, Mark Langsfeld, MD

Department of Surgery, University of New Mexico, Albuquerque, NM.

Received for publication April 6, 2007; accepted for publication April 20, 2007.

* Address for reprints: Said Yassin, MD, Department of Surgery, University of New Mexico, MSC 10-5610, 1 University of New Mexico. Albuquerque, NM 87131. (Email: syassin@salud.unm.edu).

The first 20% of the full text of this article appears below.

We report a case of a mediastinal hematoma caused by a ruptured Stanford type B aortic dissection, which resulted in delayed necrosis of the membranous wall of the left main bronchus 28 days after the successful endovascular repair of the thoracic aorta. This complication has not been reported.

Clinical Summary

A 52-year-old woman with a history of hypertension and alcoholism had a 24-hour history of severe back pain, dyspnea, and vomiting. She had a computed tomographic scan that demonstrated acute type B dissection and a mediastinal hematoma of 7 x 4.5 cm compressing the trachea, carina, bilateral main stem bronchi, and distal left lobar bronchi (Figure 1, A), with bilateral pleural effusions.


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  		Figure 1. A, Preoperative computed tomographic scan demonstrating the aortic dissection with contrast extravasation and the mediastinal hematoma compressing the airway. B, Postoperative computed tomographic scan demonstrating the successful endovascular repair with the airways remaining compressed.

 
She underwent easy intubation with a single-lumen endotracheal tube, followed by . . . [Full Text of this Article]






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