An Unusual Cause of Hemorrhagic Left Pleural Effusion

Diagnosis: Ruptured myccotic aneurysim of descending thoracic aorta caused by infection due to Salmnonella entericai, miniicking communiity-acquired p neumonia. A CT scan (figuire 1) showed a contrast-enihaticed saccular mass, 5 cm in diameter, appended to the desceniding aorta at the T8 level. AIn ovoid collectioni near the anterolateral border of the descending aorta commuinicated with the aortic lumen and was consistent with a pseuidoaneurysmn. A large left pleural effusioin, respoiisible for a passive lower lobe flatteninig, was also noted. A I-stage posterolateral thoracotomy was performed. When the chest was opened, the aneurysin ruptured completely. A femorofemoral cardiopulmonary bypass was required to control bleeding and to assure distal body perfusioll after aortic cross-clamping. lhe aneurysimi was resected, and the aorta was sutured using a prosthetic lateral patch (Dacron). S(almonella eniterica was isolated from culture of the resected aneuirystii; it was established that this strain was identical to the strain of Salmnonella enteri-ic that had earlier been isolated from pleural fluiid. Gastroscopic examination showed a slightly atrophic mucosa, which could explain the uniexpected survival