Spontaneous peri-aortic hematoma in a patient with new-onset chest pain.

Peri-aortic hematoma formation is a common sequela of esophageal rupture and aortic dissection, but non-traumatic spontaneous hematoma formation is an uncommon finding. We present the case of a spontaneous peri-aortic hematoma in a 66-year-old male with associated left atrial thrombus. This 66-year-old male presented to a local emergency department with non-radiating epigastric and mid-sternal chest pain and was found to have a non-traumatic peri-aortic hematoma of unknown etiology that developed over a period of 12 hours. Imaging revealed a newly formed left atrial thrombus causing mass effect on the pulmonary veins and a newly formed left-sided pleural effusion. The patient was subsequently transferred to an outside facility for higher level of care where additional pathological etiologies of hematoma were further excluded. Before discharge, the hematoma spontaneously dissipated and the patient was discharged on oral anticoagulants for treatment of the atrial thrombus and advised to follow-up on an outpatient basis with hematology and cardiology specialists.