Gross Hematuria Leading to Incidental Diagnosis of Chronic Type B Aortic Dissection and Penetrating Aortic Ulcer

Case Report

Abstract

A 71-year-old man with a history of hypertension, hyperlipidemia, and coronary artery disease status post coronary stent placement on dual antiplatelet therapy presented with 1 week of intermittent gross hematuria, dysuria, urinary frequency, nocturia, and lower abdominal pain. Laboratory evaluation demonstrated stable hemoglobin and renal function with significant hematuria in the absence of urinary tract infection. Computed tomography (CT) of the abdomen and pelvis revealed a 2.9-cm Bosniak category I right renal cyst, a prostatic median lobe mass protruding into the urinary bladder, and extensive atherosclerotic disease with infrarenal aortic dissection extending into the left common iliac artery. Subsequent CT angiography demonstrated ulcerated atherosclerotic plaques and a penetrating aortic ulcer involving the thoracic aorta. Transthoracic echocardiography demonstrated preserved left ventricular systolic function with mild valvular regurgitation. Vascular surgery and cardiology recommended conservative management with blood pressure optimization and outpatient surveillance because there was no evidence of visceral or lower extremity malperfusion. Hematuria evaluation, including cystoscopy, was negative. This case highlights the incidental discovery of chronic type B aortic dissection and penetrating aortic ulcer during evaluation of gross hematuria and reviews the potential vascular mechanisms contributing to hematuria in chronic aortic dissection.