Symptomatic unstable aortic hematoma: a case report.

A 69-year-old woman was admitted to our institution complaining of dyspnoea, retrosternal burning and asthenia. Medical history included a traumatic left clavicle fracture occurred two years months before. Physical examination, electrocardiogram and myocardial enzymes were normal. The patient underwent a contrast CT scan which evidenced an hematoma of thoracic aorta. The aorta was dilated from the origin of left subclavian artery as far as 75 mm of descending aorta, with a maximum diameter of 48 mm. The extimated wall thickness was 20 mm. Because of the worsening of symptoms and hypotension, a second CT scan was done, which showed an area of increased contrast agent capturing, suggestive of an incipient aortic rupture. The patient was referred to urgent endovascular repair. An endoprosthesis Valiant Thoracic Medtronic was positioned starting from the left subclavian artery up to descending aorta. Aortic angiogram performed before discharge showed correct position without endoleaks. The patient was discharged in good general condition two days later. In conclusions, in a clinical setting of chronic peri-aortic hematoma, the ingravescence of symptoms represents a strong indication for prompt endovascular treatment.