Looking back to unlock the future

Image in interventional cardiovascular medicine: what is displayed on this image? ... And do not hesitate to comment on how you would treat this case!

A 65-year-old patient with a medical history of two previous cardiac surgeries.First one was surgical aortic valve replacement with a mechanical prosthesis and the second one was surgical repair of an aneurysm in the ascending aorta with a valvulated tube.She was admitted to the emergency department because of hypotension and chest pain extending to the back, which started suddenly with an audible noise, heard by the patient.Physical examination revealed a large pulsatile haematoma in the neck and back.

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Authors

Prado Guy¹, Garzon Stefano¹, Ramalho Felipe¹, Mariani Jose¹, O. Almeida Breno¹, Caixeta Adriano¹, Galastri Leonardo¹, B. Affonso Breno ¹, Nasser Felipe¹, A. Lemos Pedro¹

1. Albert Einstein Israelite Hospital, State of São Paulo, BRAZIL