Rupture into pericardium and thoracic cavity

Rupture into pericardium and thoracic cavity

Even the slightest amount of fluid in pericardium, mediastinum or pleural cavity is suggestive of rupture of the dissection.
The cases on the down show evident rupture, with presence of extensive hematoma in above mentioned locations.
Note extreme hemothorax and hemomediastinum, causing shift of the mediastinum and compression on the pulmonary veins and even aorta.
No pericardial effusion visible.

Left: pericardial fluid / hematoma indicates rupture of the dissected aorta. Even small amounts are proving rupture, though hematoma can be extensive such as in this case.
Right: Massive hematoma caused by rupture of the dissected aorta into the mediastinum and pleural cavity, no pericaldial hematoma.

Type B aortic dissection in a non-operable patient.
At 5 days flow reappeared in false lumen. Finally at 9 months a saccular aneurysm has formed.

 The case on the above is a patient who presented with a fully thrombosed false lumen.
5 days after initial presentation this patient complained of acute chest pain mimicking the earlier episode.
Re-examination showed recurrence of flow in the false lumen, locally contained, but with alarming adhering pleural effusion.
The patient could not undergo surgical or endovascular repair for various reasons and was treated consevatively.