Chronic occlusion of the thoracic aorta: a novel cause of pleuropericardial effusions and pancytopenia

A 57-year-old man had presented with a 6-month history of worsening dyspnea, renal failure, hypertension, pancytopenia, and a continuous machinery murmur. Imaging studies revealed pleuropericardial effusions that recurred despite aspiration and suprarenal mid-thoracic aortic occlusion (AO) with extensive collateral vessels to the chest wall, rectus sheath, and diaphragm. A right axillofemoral bypass transformed his clinical course. The murmurs, renal failure, pleuropericardial drainage, and pancytopenia resolved, and his hypertension had markedly improved. The association of chronic AO with pleuropericardial effusions without peripheral edema or ascites was most likely due to increased supradiaphragmatic interstitial pressure, and the bone marrow hypoperfusion likely explains the pancytopenia. In addition to posing diagnostic challenges, chronic AO reveals unique insights into the pathogenesis of pleuropericardial effusions and pancytopenia.