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J Korean Soc Emerg Med > Volume 22(5); 2011 > Article
Journal of The Korean Society of Emergency Medicine 2011;22(5): 566-569.
Penetrating Atherosclerotic Ulcer: Another Differential Diagnosis of Widened Mediastinum
Sung Bin Chon, Chan Woo Park, Jun Hwi Cho, Kil Soo Yie
1Department of Emergency Medicine, Kangwon National University Hospital, Chuncheon, Korea. cjhemd@kangwon.ac.kr
2Department of Cardiovascular Surgery, Kangwon National University School of Medicine, Chuncheon, Korea.
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.
Key words: Aorta, thoracic, Aortic aneurysm, Aortic rupture, Chest pain, Ulcer
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