Prolonged survival following intrapleural rupture of a dissecting aortic aneurysm.

RUPTURE iS the usual cause of death in cases of dissecting aneurysm of the aorta in the acute stage. In Sheenan's series of 300 cases (1934) the pericardium was the commonest site of rupture, the pleural cavity being next in frequency. Sheenan described only two cases that survived intrapleural rupture of a dissecting aneurysm, one for 17 days, the other 19 days, and in a review of 505 cases of dissecting aneurysm in the English literature from 1934 to 1958, Hirst, Johns & Kine (1958) describe only six cases that survived for 1 month, of which one survived for 3 months. Post (1941) described the case of a 51-year-old man with multiple sclerosis who survived the rupture of a dissecting aneurysm into his left pleura for 9 weeks before dying from a septicaemia, the consequence of bed sores. Necropsy showed laminated clot at the site of rupture and Post suggested that the leak had been a slow one allowing the patient to survive the rupture. Campbell (1946) described a case of ruptured dissecting aneurysm who survived for 3 months and was shown at necropsy to have died from further rupture. In this case report, the patient remains alive and well 16 months after rupture of a dissecting aneurysm into the left pleural cavity.