CTICasesAortic Rupture and Mediastinal Hematoma Decompressing into the Right Lung
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Imaging findings
Serial CT studies show a focal area of ascending aortic wall calcification that progresses over years to develop localized outpouchings and pseudoaneurysms. This eventually culminates in a frank, contained rupture of the ascending aorta, presenting as a large mediastinal hematoma that decompresses directly into the right upper and middle lobes of the lung.
Key takeaways
Atherosclerotic plaque and calcification in the ascending aorta can progress to form penetrating atherosclerotic ulcers or pseudoaneurysms. If these lesions undergo rupture under high arterial pressure, they can decompress directly into the adjacent lung parenchyma, mimicking focal consolidative pneumonia or pulmonary hemorrhage on imaging.
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