Calcified Pleural Plaque Can Rupture Thoracic Aorta
A 72-year-old man with chronic respiratory failure caused by pulmonary tuberculosis was admitted to our hospital for a sudden onset of severe back pain. He had often experienced a mild back pain of unknown origin during the last 5 months. Five months before admission, chest plain computed tomographic scan revealed no evidence of dissection or aneurysm in the thoracic aorta and demonstrated that a left-sided sharp calcified pleural edge was contacting vertically to the thoracic descending aorta (Figure 1A). Chest plain computed tomographic scan on admission revealed the calcified pleural edge perforating through the thoracic descending aorta and a massive thoracic hemorrhage (Figure 1B). Aortography showed no aneurysm or dissection in the aorta (Figure 2). He died 8 days after admission.
At autopsy, the edge of the calcified pleural plaque across the perforation site of the aorta was very sharp. Histopathologically, no evidence of dissection, atheroma, abnormality of connective tissue, or inflammatory change was noted in the perforation site or other area of the aorta. Thus, we concluded that the calcified pleural edge incessantly pressed the aortic wall, resulting in the perforation into the thoracic aorta.