Aortic Dissection: A Dreaded Disease with Many Faces

Kasher, John A.; El-Bialy, Adel; Balingit, Peter

doi:10.1177/107424840400900309

Cited by 12 publications

(9 citation statements)

References 22 publications

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“…The clinical manifestations of aortic dissection are diverse with a broad spectrum of conditions and differential diagnoses at presentation [2][3][4]. In type A dissection, patients typically present with severe chest pain, back pain, abdominal pain, syncope, stroke, congestive heart failure or blood pressure differentials.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients present with severe, sharp pain of sudden onset, located in the anterior chest that radiates to the back and the interscapular region. Clinical presentation, however, is diverse with a wide range of symptoms, none of which pathognomonic for aortic dissection [3]. For that reason a high clinical index of suspicion is necessary.…”

Section: Introductionmentioning

confidence: 97%

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Acute aortic dissection mimicking cholecystitis

et al. 2007

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Zusammenfassung. Grundlagen: Die akute Aortendissektion stellt einen lebensbedrohlichen Notfall dar und ist mit einer hohen Morbiditä t und Mortalitä t vergesellschaftet. Die klinischen Symptome sind vielfä ltig, und es kommt rasch zu ernsthaften Komplikationen, sodass die Diagnose nicht einfach ist und oft zu spä t gestellt wird.Methodik: Wir berichten ü ber eine 48-jä hrige Patientin, mit einer kurzen Anamnese von starken, epigastrischen Schmerz. Bei Aufnahme im lokalen Krankenhaus wird zunä chst eine Gastritis und Cholezystitis diagnostiziert.Ergebnisse: Nach laparoskopischer Cholezystektomie -einer histopathologisch chronisch entzü ndlich ver-ä nderten Gallenblase ohne Lithiasis -wurde die Patientin hä modynamisch instabil, und eine Computertomographie ergab die Diagnose einer akuten Typ-A-Aortendissektion sowie einer Perikardtamponade. Nach sofortiger Ü berstellung in unser Krankenhaus wurde ein suprakoronarer Aszendensersatz in tiefer Hypothermie und Kreislaufstillstand durchgefü hrt.Schlussfolgerungen: Bei bis zu 50% der Patienten mit Aortendissektion kommt es initial zu einer Fehldiagnose, da klassische Symptome oft nicht vorhanden sind. Bei epigastrischen Schmerzen und Symptomen einer Cholezystitis sollte die Differentialdiagnose einer Aortendissektion gestellt werden.Schlü sselwö rter: Aortendissektion, Cholezystitis, Symptome, Diagnose.Summary. Background: Acute aortic dissection is a lifethreatening medical emergency that carries a high rate of morbidity and mortality. Because presenting clinical features are diverse and serious complications occur rapidly, diagnosis is difficult to make and often missed.Methods: We present a 48-year-old patient with a 4 h history of severe epigastric pain. Upon admission to the local hospital gastritis and cholecystitis were diagnosed.Results: After laparoscopic cholecystectomy -of a histopathologically chronically inflamed gallbladder without lithiasis -the patient became hemodynamically instable, a type-A aortic dissection and pericardial tamponade were detected on CT. She was urgently transferred to our hospital and underwent an ascending aorta and hemiarch replacement in deep hypothermia and circulatory arrest.Conclusions: In up to 50% of patients with aortic dissection diagnosis is missed or delayed, since classical findings are often absent. The possibility of aortic dissection should be considered in patients suffering from intense abdominal pain diagnosed as cholecystitis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Acute aortic dissection mimicking cholecystitis

et al. 2007

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“…The Stanford classification of aortic dissection distinguishes between type A and type B. In type A, the dissection involves the ascending aorta 4. In type B, only the descending aorta is involved.…”

Section: Discussionmentioning

confidence: 99%

Dissecting the unspeakable: a fatal case of aortic dissection

et al. 2015

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SUMMARYA 47-year-old man with diabetes and hypertension presented with sudden onset of chest pain and subsequently developed expressive aphasia. Brain imaging revealed multiple areas of ischaemic infarcts. Transoesophageal echocardiogram revealed aortic dissection with a free-floating thrombus on the dissection flap, which was the source of emboli. Given the poor prognosis, surgical intervention was not pursued and artificial support was withdrawn. Aortic dissection is a highly fatal condition with varied presentation including heart failure, myocardial infarction, neurological deficits, abdominal pain or acute renal failure. Aortic dissection is a relatively uncommon but catastrophic condition. A high degree of clinical suspicion is required for early and accurate diagnosis since mortality is high and increases by the hour. The mechanism for stroke in our case was due to an arteryto-artery embolism from a thrombus, which developed on the intimal surface of the dissected artery. This is an infrequent complication with a very unique mechanism. BACKGROUND

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“…Differential diagnosis includes myocardial infarction, acute pericarditis, pulmonary embolism, decompensation with acute pulmonary oedema, hypertensive crisis and mesenteric infarction [17].…”

Section: Dissezione Aorticamentioning

confidence: 99%

“…La diagnosi differenziale comprende una serie di condizioni patologiche quali infarto del miocardio, pericardite acuta, embolia polmonare, scompenso con edema polmonare acuto, crisi ipertensiva, infarto mesenterico [17].…”

Section: Classificationunclassified

Multidetector-row CT evaluation of nontraumatic acute thoracic aortic syndromes

2007

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Acute thoracic aortic syndromes encompass a spectrum of emergencies presenting with acute chest pain and marked by a high risk of aortic rupture and sudden death. These include nontraumatic disease entities of the thoracic aorta, namely, dissection, intramural haematoma, penetrating atherosclerotic ulcer and aneurysm rupture. In clinical practice, the most frequent imaging procedure used in the diagnostic assessment of these diseases is computed tomography (CT), which, thanks to recent technological developments [multidetector-row computed tomography (MDCT)], affords important diagnostic possibilities and very interesting future perspectives. This paper on the use of MDCT in the evaluation of acute thoracic nontraumatic aortic syndromes illustrates the examination technique and the key imaging findings related to each disease. Moreover, the role of MDCT for planning specific treatment is also highlighted.

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Aortic Dissection: A Dreaded Disease with Many Faces

Cited by 12 publications

References 22 publications

Acute aortic dissection mimicking cholecystitis

Acute aortic dissection mimicking cholecystitis

Dissecting the unspeakable: a fatal case of aortic dissection

Multidetector-row CT evaluation of nontraumatic acute thoracic aortic syndromes

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