Fever with dissecting aneurysm of the aorta

Following acute aortic dissection, in two of the four cases we describe the patients experienced a prolonged febrile syndrome which spontaneously resolved five and 11 weeks later. Because of fever and a murmur of aortic regurgitation, the two other patients with aortic dissection were initially treated for acute bacterial endocarditis. These four cases serve to re-emphasize fever as an important clinical manifestation of dissecting aneurysm of the aorta.     

Atrioventricular block complicating acute streptococcal tonsillitis

A 38 year old woman presented with severe weakness, high fever, and sore throat. Physical examination showed follicular tonsillitis and bradycardia caused by a atrioventricular block. Within 24 hours a normal sinus rhythm was regained but slight transient ST-T changes compatible with myocarditis were evident. Throat culture grew Streptococcus haemolyticus group A.     

A giant dissecting aneurysm of ascending aorta

Aortic aneurysm is a serious clinical challenge for the cardiologist. Aneurysm expansion frequently associated with significant dissection and rupture risk. Currently available diagnostic modalities make earlier diagnosis and therapy possible hence giant aneurysm with dissection is relatively rare. In this case report, we present a patient with giant aortic aneurysm with dissection.     

Dissecting aneurysm of the aorta complicating hypertension

After a short period of slight limitation of physical activity, as shown by dyspnea on movement, an elderly man with persistent hypertension, dilatation of the aorta, and cardiac enlargement, and an aortic diastolic murmur, had a brief attack of substernal oppression, followed three weeks later by agonizing substernal pain, which continued for four days without remission and was accompanied by equally severe lumbar pain.The character and duration of this pain served to rule out the usual forms of angina pectoris; the continued myocardial sufficiency, and the absence of physical, including electrocardiographic, signs discouraged a diagnosis of coronary thrombosis.At necropsy, the finding of a dissecting aneurysm of the aorta, apparently of several weeks development, judging from the formation of an endothelial lining in the upper part of the new tract, provided an admirable explanation of the clinical course and symptoms. The initial rupture of the intima may be associated with the first attack of substernal distress; the splitting of the media produced the extreme pain of the second attack. Throughout the descending thoracic and abdominal aorta the advancing extravasation of blood brought about, it may be supposed, a rapid dissection with little or transient pain; but the obstruction to the progress of the aneurysm in the region of the bifurcation was productive of the pain in the lumbar region. Finally, the terminal rupture occurred through the adventitia into the left mediastinum, within which the blood was confined until the perforation into the pleural cavity.From the pathological standpoint, the comment may be added that in the aorta, as elsewhere, sclerotic changes were not marked, and there was no evidence whatever of syphilis. Both of these facts are worthy of emphasis. The later and more marked changes in the development of atherosclerosis, namely, the fatty and calcareous deposits, tend to separate the intima from the media, and an injury to the former is less likely to involve the latter; while in the earlier stage, with what Adami⁴ called the “hyaline fibroid” lesions, the connection between the two coats is intact, and an intimal tear is carried through into the media. In regard to the second point, the lamellar arrangement of the elastic fibers of the media is the basis of the formation of the dissecting aneurysm, for the blood finds it easier to separate the weak connective tissue binding these layers together and make its way along the vessel, than to rupture the tough elastic fibers which lie directly in its course. Syphilitic mesaortitis destroys this orderly arrangement of the medial lamellae, thus preventing dissection, and the syphilitic aneurysm remains localized.     

Atrioventricular block complicating acute streptococcal tonsillitis.

A 38 year old woman presented with severe weakness, high fever, and sore throat. Physical examination showed follicular tonsillitis and bradycardia caused by a atrioventricular block. Within 24 hours a normal sinus rhythm was regained but slight transient ST-T changes compatible with myocarditis were evident. Throat culture grew Streptococcus haemolyticus group A.     

Lung cancer simulating dissecting aneurysm of the aorta]

The report analyzes a rare case of lung cancer presenting as a dissecting aortic aneurysm. A 59-year-old patient was admitted to the Department of Cardiosurgery of the Institute of Cardiology, Poznań Medical School, with a preliminary diagnosis of dissecting aneurysm of ascending aorta. The patient had hypertension treated for 5 years and 3 year history of retrosternal pains. He had smoked 20 cigarettes daily for 20 years. On admission a strong chest pain radiating into the ++inter-scapular region was reported. After two days the radiation extended into the lumbosacral area. Blood pressure was 180/100 mmHg. After 7 days paresis of the lower extremities occurred. Ecg showed only hypertrophy of the left ventricle. Chest X-ray revealed dilatation of the mediastinum and enlargement of the lungs, without focal changes. Echo (M + 2D + Doppler) suggested aortic wall dissection in the ascending part and the arch. The DSA examination did not reveal the dissection, which in turn suggested mediastinal tumor. TC presented an extensive infiltration of the upper-medial part of the right lung and invaded right mediastinum. The final diagnosis, oat cell carcinoma, was established after the histopathological analysis of a biopsy specimen taken in the course of bronchoscopy. The patient died at home after two months of oncological treatment. Autopsy was not performed. In spite of considerable progress of the diagnostic technics both dissecting aortic aneurysm and lung cancer still present a very difficult clinical problem.     

The carotid pulse in dissecting aneurysm of the aorta

In five patients with acute aortic type I dissection a deep early systolic notch was recorded on the carotid pulse tracing. This peculiar feature of the carotid pulse was quite comparable to the aspect of the continuous wave Doppler ultrasound recorded along the carotid arteries. It can be explained by the temporary interruption of blood flow caused by false lumen in the artery. Therefore the carotid pulse can provide to the clinician a good help to the diagnosis of aortic dissection especially in case of nontypical presentation.     

主动脉夹层动脉瘤外科治疗分析

目的 探讨主动脉夹层动脉瘤的外科治疗原则及效果。方法 回顾性研究5年期间收治的52例主动脉夹层动脉瘤,其中DeBakeyⅠ、Ⅱ型(stanford A型)10例,Ⅲ型(B型)42例。结果非手术治疗患者中5例因突发夹层动脉瘤破裂,心室纤颤或心力衰竭死亡,手术患者中2例死亡(13.3％),术后随诊4月～5年,疗效满意。结论 手术是治疗主动脉夹层动脉瘤的有效措施,尤其是动脉瘤破裂先兆,主要脏器严重缺血,或非手术治疗难以奏效的顽固性患者,应积极手术治疗。