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Painless Left Hemorrhagic Pleural Effusion*: An Unusual Presentation of Dissecting Ascending Aortic Aneurysm

Stephen Little, MD; John Johnson, MD, FCCP; Be-Yung Moon, MD; Sanjay Mehta, MD
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*From the Division of Respirology, Department of Medicine (Drs. Little, Johnson, and Mehta), and the Department of Cardiovascular Surgery (Dr. Moon), London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.

Correspondence to: Sanjay Mehta, MD, Division of Respirology, London Health Sciences Centre, Victoria South St Campus, 375 South St, London, Ontario, Canada, N6A 4G5, e-mail: sanjay.mehta@lhsc.on.ca



Chest. 1999;116(5):1478-1480. doi:10.1378/chest.116.5.1478
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Aortic dissection is a catastrophic event that is commonly associated with severe pain, massive hemorrhage, and high mortality. In this report, we present the case of a 31-year-old man who presented with painless, hemorrhagic left pleural effusion. Further investigation revealed a 9-cm dissecting ascending aortic aneurysm that was thought to be due to a congenitally bicuspid aortic valve. We suggest that ascending aortic aneurysm be included in the differential diagnosis of hemorrhagic pleural effusion, even in the absence of the classic features of aortic dissection, such as chest pain, advanced age, or history of hypertension.

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