J Korean Soc Emerg Med.  2011 Oct;22(5):566-569.

Penetrating Atherosclerotic Ulcer: Another Differential Diagnosis of Widened Mediastinum

• Chon SB
• Park CW
• Cho JH
• Yie KS

Abstract

A widened mediastinum is not always caused by aortic dissection, which is the default diagnosis among emergency physicians. Other acute aortic syndromes should be included in differential diagnosis, such as penetrating atherosclerotic ulcer (PAU), intraluminal hematoma, aneurismal leak, and traumatic transection. When an ulcerative lesion is found in the atherosclerotic aorta, especially the descending aorta of an elderly, PAU should be considered as the possible cause of widened mediastinum. We present a case of PAU, the diagnosis of which was delayed without the knowledge of PAU even though thoracic computed tomography showed widened mediastinum and suspious pericardial effusion.

Keyword

Aorta; thoracic; Aortic aneurysm; Aortic rupture; Chest pain; Ulcer

MeSH Terms

Aged
Aorta
Aorta, Thoracic
Aortic Aneurysm
Aortic Rupture
Chest Pain
Diagnosis, Differential
Emergencies
Hematoma
Humans
Mediastinum
Pericardial Effusion
Ulcer