LEFT PLEURAL HEMORRHAGIC EFFUSION - A PRESENTING SIGN OF THORACIC AORTIC DISSECTING ANEURYSM

Left hemorrhagic pleural effusion was the presenting sign of painless aortic dissecting aneurysm in two elderly hypertensive patients. Compu ted tomography (CT) of the chest revealed the aneurysmal dilatation of the thoracic aorta and an intimal nap connecting its descending part with the left pleural space. The patients were treated conservatively with blood transfusions and drugs directed to control blood pressure. The first reported 71-year-old patient remains in stable condition for 16 months without evidence of recurrent active aortic dissection. The second 85-year-old patient remained in stable condition for 28 days, but finally had a second fatal episode of dissection into the left ple ural space. The differential diagnosis of nontraumatic left hemorrhagi c pleural effusion in an elderly hypertensive patient should include d issecting aneurysm of the descending thoracic aorta and CT of the ches t should be performed as the next preferable diagnostic procedure.