Stanford Type B Aortic Dissection Presenting as a Massive Hemothorax: A Case Report

Background: Stanford Type B aortic dissection (TBAD) is a critical vascular emergency typically presenting with acute tearing chest or back pain. While pleural effusions are common in TBAD, presentation as a massive hemothorax is a rare and life-threatening complication that often signals aortic rupture, traditionally necessitating urgent surgical or endovascular intervention. Case Presentation: We report the case of a 40-year-old female with a ten-year history of hypertension who presented with severe chest pain, diaphoresis, and dyspnea. Physical examination revealed signs of massive left-sided pleural effusion, and laboratory evaluation demonstrated severe anemia and acute kidney injury. Computed Tomography (CT) angiography confirmed a Stanford Type B aortic dissection extending from the left subclavian artery to the inferior mesenteric artery, complicated by a massive left hydropneumothorax. Crucially, the celiac trunk, superior mesenteric artery, and renal arteries originated from the true lumen, preserving end-organ perfusion. Management and Outcome: Despite the presence of hemothorax, the patient was hemodynamically responsive to resuscitation. A left intercostal chest tube was placed, draining hemorrhagic fluid. She was managed conservatively with aggressive anti-impulse therapy (strict blood pressure control). The patient stabilized rapidly without the need for Thoracic Endovascular Aortic Repair (TEVAR), renal function normalized, and she was discharged on the seventh day. Conclusion: This case illustrates that while hemothorax in the setting of Type B aortic dissection is a red flag for rupture, it does not universally mandate surgical repair. In hemodynamically stable patients with preserved visceral perfusion, a conservative approach comprising tube thoracostomy and strict blood pressure control can yield successful outcomes.