[Spontaneous rupture of the ascending aorta. Rare form of parietal ulceration on angiography, with pericardial effusion].

A localised rupture of the aorta, notably less frequent than a true dissection, is often difficult to diagnose and should be attentively sought for whenever faced with acute chest pains resulting from a suspected aortic lesion. The authors' observation show, on aortography, a small ulcer-like projection on the internal wall of the dilated ascending aorta, only visible on an antero-posterior view. The true scientific value of this image is arguable and we are reminded of the rigorous routine needed in any angiographical examination. The particular case in question involves a subadventitial ulcer which could be the initial stage of a true dissection. The echography demonstrated the presence of a pericardial effusion (whose dreaded prognostic value is well known), but no aortic lesion. The authors feel that the diagnostic reliability of echography, computed tomography and digital subtraction angiography warrants further systematic study. It would appear that direct aortography until otherwise proved, remains the only real method capable of detecting these localised ruptures at an early stage, before their spontaneous and dramatic evolution into perforation or a true dissection; and so benefiting the patient from surgical repair work only without prosthesis insertion.