Hemoptysis as an Unusual Herald of Penetrating Aortic Ulcer in a Patient with Prior Mediastinal Irradiation: A Case Report

Penetrating aortic ulcer (PAU) is a critical component of acute aortic syndromes, typically occurring when an atherosclerotic plaque breaches the internal elastic lamina. While traditionally seen in elderly patients with chronic hypertension, there is a growing recognition of its occurrence as a late complication of thoracic radiotherapy. We present the case of a 51-year-old male, previously treated for Hodgkin lymphoma, who presented with hemoptysis. Multidetector computed tomography (CT) revealed a localized alveolar hemorrhage in the left upper lobe, immediately adjacent to a 12 mm penetrating ulcer of the descending thoracic aorta. This case underscores the atypical clinical presentation of PAU and the need for a high index of suspicion when evaluating thoracic symptoms in patients with a history of mediastinal irradiation.