CTICasesChronic Type B Aortic Dissection with False Lumen Aneurysm
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Imaging findings
Chest radiography shows complete whiteout of the left hemithorax, which was initially managed with a pigtail pleural drain for a presumed empyema. Emergency CT angiography reveals a massive false lumen aneurysm originating from a chronic Type B aortic dissection, compressing the left main bronchus and collapsing the left lung, with the pleural drain safely positioned in a small accompanying uncomplicated pleural effusion without perforating the aneurysm.
Key takeaways
Large thoracic aortic aneurysms or chronic dissections can present as complete hemithorax whiteout, mimicking massive empyema or pleural effusion. Placing a chest tube blindly using a blind or minimally guided technique in this scenario carries a catastrophic risk of aneurysm rupture, emphasizing the critical importance of reviewing historical imaging or obtaining cross-sectional imaging before pleural intervention.
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