Thoracic aortic injuries result in pseudoaneurysm formation in 1%-2% of cases if unrecognized. Spontaneous cases are very rare (1) . Treatment strategy has shifted from surgery towards endovascular techniques, but use is limited with specific anatomical considerations and complications. Particularly in high risk patients, endovascular approach offers lower morbidity and mortality (2, 3) . A 51 year-old male patient with renal failure experienced dyspnea during dialysis. Chest radiogram revealed

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... massive left-sided pleural effusion. Thoracic computerized tomography documented pseudoaneurysm in thoracic aorta distal to left subclavian artery (48.5x29.1 mm) (Figures 1, 2) . There was no history of trauma or percutaneous/ surgical intervention; possibly the atherosclerotic plaque weakened the wall and lead to aortic rupture during a hypertensive attack and pseudoaneurysm developed. Successful endovascular treatment was performed ( Figure 3 ). Left hemithorax was tube-drained after the procedure (defibrinated blood), because preceding intervention could decompress the pseudoaneurysm sac and lead to rupture. The postoperative course was uneventful.