Pseudoaneurysms formation with hemoptysis after thoracic aortic dissection stent implantation: a case report

Background: Aortic dissection is a surgical emergency. It refers to a pathological change in which the blood in the aortic lumen enters the media of the aorta from the tear of the intima of the aorta, which separates the media and expands along the long axis of the aorta. This results in a pathological change in the separation of the true and false lumens of the aorta. Blood pressure and aortic middle layer disease are the main causes of aortic dissection. Thoracic endovascular aortic repair (TEVAR) can successfully treat this disease. However, pseudoaneurysm formation is a common and important complication after TEVAR, and its rupture is life-threatening. Pseudoaneurysm formation can be found in patients after TEVAR, which requires reoperation. Case presentation: A 43-year-old Chinese man was hospitalized with "sudden hemoptysis with chest and back pain and fever for 4 hours. Examination in the emergency room revealed a thoracic aortic pseudoaneurysm with hematoma formation after aortic dissection stenting, which compressed the left lower lung. The patient's symptoms disappeared after a second thoracic aortogram stent implantation. Conclusions: Patients with acute aortic dissection should be treated with caution. Especially for patients with aortic pseudoaneurysm after aortic dissection stent implantation, the local arterial wall is relatively weak after stent implantation, and continuous bulging may form pseudoaneurysm. Continuous progression of pseudoaneurysm and hematomas compression of lung tissue leading to hemoptysis are relatively rare in clinical practice. If not handled in time, large-scale lung tissue necrosis and para-stent infection or asphyxia are likely to occur. In case of symptomatic pseudoaneurysm formation, aortic angiogram stent implantation should be performed in time.