Acute aortic dissection with painless paraplegia: report of 2 cases

Acute aortic dissection is often a life-threatening event that usually presents as a sudden, severe, exquisitely painful, ripping sensation in the chest or back. There are a few reports of atypical findings or no pain in the literature. We report 2 patients with painless acute aortic dissection who presented to the emergency department (ED) with sudden onset paraplegia.     

Chronic Aortic Dissection in a Young Adult

Background: Acute aortic dissection is a life-threatening disease that is often a diagnostic challenge in the Emergency Department (ED). Patients with acute aortic dissection often have underlying hypertension and atherosclerotic disease, and commonly present with acute-onset severe chest or back pain in their sixth or seventh decades of life. Aortic dissection, however, can also be seen in patients < 40 years old and may present chronically, with symptom duration longer than 2 weeks. Objective: We present an unusual case of chronic aortic dissection in a young patient, followed by a review of the literature on chronic aortic dissections and aortic dissections in young patients. Case Report: We report a case of chronic aortic dissection in a 32-year-old man with a history of untreated hypertension who presented to the ED with palpitations and mild shortness of breath. Conclusion: Acute and chronic thoracic aortic dissections can occur in patients of all ages, as well as in patients with atypical signs and symptoms.     

Emergency Bedside Ultrasound Diagnosis of Superior Mesenteric Artery Dissection Complicating Acute Aortic Dissection

Background

A timely diagnosis of aortic dissection is associated with lower mortality. The use of emergent bedside ultrasound has been described to diagnose aortic dissection. However, there is limited literature regarding the use of bedside ultrasound to identify superior mesenteric artery dissection, a known high-risk feature of aortic dissection.

Objective

Our aim was to present a case of superior mesenteric artery dissection identified by bedside ultrasound and review the utility of bedside ultrasound in the diagnosis of aortic emergencies.

Case Report

We report a case of superior mesenteric artery dissection found on emergent bedside ultrasound in a 46-year-old male complaining of abdominal pain with a history of cocaine abuse and prior aortic dissection. Bedside ultrasound in the emergency department revealed an intimal flap in the descending aorta with extension into the superior mesenteric artery prompting early surgical consultation before computed tomography because of concern for acute mesenteric ischemia.

Conclusion

Superior mesenteric artery dissection is a high-risk feature of aortic dissection and can be identified with emergent bedside ultrasound.     

Aortic dissection and turner’s syndrome: case report and review of the literature

Cardiovascular abnormalities are frequently encountered in patients with Turner’s syndrome. These include coarctation of the aorta, aortic root dilatation, bicuspid aortic valve, atrial and ventricular septal defects. Aortic dissection is a rare but devastating complication of Turner’s syndrome that usually occurs in adulthood. We report a case of Turner’s syndrome with coarctation of the aorta and chronic aortic dissection, and review the relevant literature. There have been 21 prior reported cases of aortic dissection in patients with Turner’s syndrome. Possible etiologic factors contributing to the occurrence of aortic dissection in this syndrome are protean. They include the presence of cystic medial necrosis, coarctation of the aorta, bicuspid aortic valve, aortic root dilatation, and hypertension, although cases of aortic dissection and Turner’s syndrome have been described in patients without any risk factors. As our knowledge of the natural history of congenital heart defects and risk factors for aortic dissection in Turner’s syndrome is limited, periodic cardiac evaluation of these patients may be warranted. Early recognition and treatment of this potentially lethal complication of Turner’s syndrome is essential.     

Emergency Cesarean Section Due to Acute Aortic Dissection Type A (Debakey I) without Marfan Syndrome: A Case Report and Review of the Literature

Background

Acute aortic dissection during pregnancy is an uncommon but important emergency due to its lethal risk to both mother and child. The dissection usually involves the ascending aorta or the aortic arch. Although additional affection of the descending aorta up to bifurcation is possible, further increasing the risk of organ malperfusion, full-length aortic dissection (DeBakey I) is known to be very rare. Dissection during pregnancy has been reported predominantly in combination with Marfan syndrome. Acute aortic dissection Stanford type A (AADA) DeBakey I during pregnancy without signs of Marfan syndrome as a warning signal is very uncommon in the current literature.

Objectives

The etiology, diagnosis, differential diagnosis, and management of this rare disease are discussed in relation to the current literature.

Case Report

We report the case of an athletic 34-year-old woman in the third trimester of pregnancy, without history of previous diseases, who presented to our Emergency Department after collapsing. In the resuscitation department, an emergency cesarean section was performed due to the start of circulation failure in the mother. Computed tomography scan revealed a severe aortic dissection starting from 1 cm distal the aortic valve over the full length up to the iliac arteries, involving the brachiocephalic and carotid arteries up to the level of the larynx. Emergency replacement of the ascending aorta and the aortic arch was performed. Both the mother and baby survived and were doing well 1 year postoperatively.

Conclusion

This alarming result of AADA (DeBakey I) in late pregnancy without obvious warnings such as Marfan syndrome illustrates the importance of performing early imaging in similar cases.     

Painless limited dissection of the ascending aorta presenting with aortic valve regurgitation

Aortic dissection is a medical emergency carrying high morbidity and mortality. Prompt diagnosis is sometimes difficult because of its varying presentations, but it is critical to the achievement of good clinical outcomes. This report describes 2 cases of painless aortic dissection that presented with aortic valve regurgitation. In both, the dissection was limited to the ascending aorta just distal to the aortic valve. These dissections were diagnosed by transthoracic and transesophageal echocardiography.     

Headache: an unusual presentation of aortic dissection.

The most common presenting symptom of aortic dissection is chest pain - headache as the initial manifestation is rare. We report a patient with a history of hypertension who presented with severe bifrontal headache, and was found to have an acute aortic dissection in the absence of carotid artery dissection. A discussion of the atypical presentation and possible pathophysiology follows.     

急性Stanford A型主动脉夹层手术患者术中压力性损伤标准护理方案的构建

目的:构建急性Stanford A型主动脉夹层手术患者术中压力性损伤预防的标准护理方案。方法:2020年1—6月在文献检索、文献综述以及案例回顾总结急性主动脉夹层患者术中压力性损伤发生、发展的临床特征基础上,初步构建急性Stanford A型主动脉夹层手术患者术中压力性损伤患者预防的标准护理方案,采用德尔菲法对8名护理专家进行2轮咨询,对各项措施进行评分、修订并最终完成完整的干预方案。结果:2轮专家咨询问卷回收率均为100%;2轮函询专家权威系数分别为0.79、0.83。构建一套完整的急性Stanford A型主动脉夹层手术患者术中压力性损伤标准护理方案,包括3个维度、11项护理措施与26个条目。结论:本研究构建的急性Stanford A型主动脉夹层手术患者术中压力性损伤患者预防的标准护理方案的专家积极性和权威程度高,所形成的条目能很好地满足患者的护理需求,可以为此类手术患者术中压力性损的预防提供指导意见。     

初诊为急性冠脉综合征的主动脉夹层患者的经验教训一例

急性主动脉夹层起病凶险,临床表现多样,初诊极易误诊。而按照其他疾病治疗容易加重急性主动脉夹层,导致患者病情恶化。本研究报道1例初诊为急性冠脉综合征的急性主动脉夹层患者诊治过程中的经验教训,为类似病例的多方位检查及诊断提供参考。     

Percutaneous coronary stenting in guide-induced aortocoronary dissection: angiographic and CT findings

We report here on a case of accidental aortocoronary dissection that occurred during the engagement of a guiding catheter. This resulted in an antegrade dissection into the right coronary artery, and a retrograde extension of the dissection into the Sinus of Valsalva and the ascending aorta up to the aortic arch. It was successfully treated with a stent deployment at the RCA ostium; this restored optimal coronary blood flow and there was a complete resolution of the aortic dissection as was documented by coronary angiography and the follow-up CT scan.     

Ischaemic infarction masking aortic dissection: a pitfall to be avoided before thrombolysis

Acute aortic dissection complicated by stroke is not uncommon but may be difficult to evaluate, especially in patients with impaired mental status. We report a patient who had evidence of an ischaemic stroke but was fortuitously not given thrombolytic treatment. She was subsequently found to have an extensive aortic dissection involving both carotid arteries. The decision of whether to give thrombolytic treatment is understandably an urgent one, but careful attention should be paid to subtle signs and symptoms such as atypical chest pain and carotid bruits that might suggest aortic dissection, especially involving the carotid arteries. There should be a high index of suspicion for acute aortic dissection in such cases and a low threshold for performing carotid ultrasound.     

Biatrial compression caused by intrapericardial hematoma secondary to ruptured type I acute aortic dissection following aortic valve replacement

Ruptured aortic dissection after aortic valve replacement (AVR) is uncommon and rarely diagnosed premortem. We report a patient with a ruptured type I aortic dissection and biatrial tamponade 2 months after AVR caused by loculated intrapericardial hematoma.The diagnosis was made by transthoracic echocardiography and confirmed at operation.     

Acute type B aortic dissection: update on proper management

This study aims to collect and present all current literature data on the diagnostic and therapeutic management of acute type B aortic dissection. It includes a comprehensive literature search utilizing the following keywords: ‘acute aortic dissection’, ‘type B aortic dissection’, ‘conservative management’, ‘endovascular repair’, ‘open surgery’ and ‘diagnosis’. Uncomplicated acute type B aortic dissection can be effectively managed using conservative management, although open repair is indicated only for complicated cases. Endovascular repair shows promising results in selected patients with increased perioperative risk and without contraindications. Recent evidence supports endovascular repair even in uncomplicated cases, although more data on long-term outcomes are needed. Early risk stratification and evaluation of the patient is crucial for selection of optimal management.     

Painless acute aortic dissection presenting as left lower extremity numbness

Acute aortic dissection may have variable presentations, making the diagnosis clinically challenging. Acute neurologic syndromes secondary to dissection of the aorta are uncommon. However, including aortic dissection in the differential diagnosis is imperative. This report describes the first reported case of an acute thoracic aortic dissection presenting with the chief complaint of unilateral lower extremity numbness. Peripheral ischemic neuropathy as the result of vascular occlusion is uncommon. The pathophysiology and clinical manifestations of ischemic neuropathies in the setting of acute aortic dissection are discussed.     

Emergency repair of aortic dissection in a 37-week parturient: a case report

Aortic dissection is a life-threatening condition with a 50% mortality rate in the first 48 hours and a 3-month mortality rate of 90% in untreated patients. Aortic dissection is a rare complication of pregnancy, but there is significant morbidity and mortality for the mother and infant. A 43-year-old woman with a 37-week intrauterine pregnancy was admitted to the emergency department 6 hours after the onset of tightness in her throat and neck pain. She described the pain as similar to pain she experienced with a myocardial infarction 2 years previously. Other pertinent history included hypertension, gestational diabetes, coronary artery disease, and a family history of aortic dissection. The patient was initially misdiagnosed. Transthoracic echocardio-" gram and computed tomography scan revealed a type A thoracic aortic dissection extending into the abdominal aorta. An emergency aortic repair and cesarean section were successfully performed. Recognition of aortic dissection and an evidence-based, collaborative approach to optimize treatment and recovery are vital to the patient's survival. The purpose of this article is to highlight successful management of aortic dissection in a parturient and to broaden the body of literature on the topic.     

Bicuspid aortic valve stenosis complicated by descending aortic dissection mimicking coarctation of the aorta.

We report a rare case of bicuspid aortic stenosis complicated by an ascending aortic aneurysm and aortic dissection of DeBakey type IIIb. A 35-year-old woman was admitted to our hospital to examine her systolic murmur identified at birth. Severe aortic stenosis, dilatation of the ascending aorta, and the narrow color flow signal in the descending aorta were detected by transthoracic echocardiography. Initially, coarctation of the descending aorta was suspected, but aortic dissection, DeBakey type IIIb, was revealed by transesophageal echocardiography. Transesophageal echocardiography is indicated when only insufficient information is available on valve and aortic morphology in patients with bicuspid aortic valve.     

Painless aortic dissection presenting as hoarseness of voice: cardiovocal syndrome: Ortner's syndrome.

Most of the neurological manifestations of the aortic dissection are due to neuronal ischemia secondary to either extension of the dissection process into a branch artery, or compression of an artery by the false lumen of the dissecting aortic hematoma. However, the enlarging false lumen may directly compress on an adjacent nerve, causing neuronal injury resulting in neurological symptoms. This may particularly take place when a distal intimal tear does not decompress the false lumen, resulting in formation of an expanding blind pouch. About 10% of aortic dissections are painless and may present with symptoms secondary to the complications of the dissection. Although cardiovocal syndrome, or Ortner's syndrome (hoarseness of voice due to involvement of recurrent laryngeal nerve in cardiovascular diseases) has been described with aortic dissection, it has not been reported as an initial presenting feature of this disorder. This report describes the first case of painless aortic dissection presenting with hoarseness of voice, the cardiovocal syndrome. The hoarseness remained the only symptom throughout the entire course of the disease. The aortic dissection was not suspected initially. During surgical exploration, the recurrent laryngeal nerve was found compressed by the false lumen at the level of aortic arch. Aortic root replacement was performed successfully, resulting in complete resolution of the hoarseness. The neurological manifestations of aortic dissection, and the cardiovocal syndrome, are discussed.     

Traumatic type B aortic dissection causing near total occlusion of aortic lumen and diagnosed by transthoracic echocardiography: A case report.

A true dissection of the descending thoracic aorta resulting from blunt chest trauma is a relatively rare injury compared with aortic transsection and occurs mostly in the region of the aortic isthmus. It is a life-threatening condition that requires rapid and accurate diagnosis. In this case, we report a patient with Stanford type B aortic dissection caused by decelerating trauma of the chest in a motor vehicle accident causing near total occlusion of the aortic lumen. The diagnosis was made by transthoracic echocardiography and confirmed by aortography.     

Early systolic notched peripheral Doppler flow pattern as an indicator of functional obstruction of the common iliac artery after iatrogenic aortic dissection: a case report

We report on a 57-year-old male patient with typical claudication localised in the right thigh, following aortic valve replacement. The ankle brachial index under resting conditions is within normal range on both sides. A conspicuous monomorphic double-humped peripheral Doppler flow pattern with an early systolic notch extending to the baseline can be registered in all the arteries of the right lower limb. The flow patterns of all other peripheral arteries are properly configured and of triphasic morphology. As the underlying cause of the pathologically altered Doppler flow morphology, aortic dissection Type A can be detected, extending from the former cannulation site of the ascending aorta into the right common iliac artery. Its dissection membrane functionally occludes the right common iliac artery in the early systole, the effect being brief and reversible. The pathogenesis of this morphologically altered Doppler flow pattern and potential differential diagnoses are discussed in this case report, also considering the current literature.