Mediastinal hematoma: another lethal sign of aortic dissection.

Acute compressive hemomediastinum due to type A acute aortic dissection in a 70-year-old man caused acute simultaneous obstruction of pulmonary artery and superior vena cava, leading to sudden death, presenting acute progressive bruising of the upper half of the body and subsequent massive hemoptysis. Computed tomography scanning revealed acute severe stenosis of the superior vena cava and right pulmonary artery by mediastinal hematoma. Mediastinal hematoma combined with simultaneous obstruction of pulmonary artery and superior vena cava is a rare entity and should be recognized as one of the acutely fatal signs of type A dissection.