Clinical, Diagnostic, and Management Perspectives of Aortic Dissection

Khan, Ijaz A.; Nair, Chandra K.

doi:10.1378/chest.122.1.311

Cited by 520 publications

(450 citation statements)

References 152 publications

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“…Despite major advances in diagnostic imaging and progress in surgical management, the mortality rate is high, 2,3 the diagnosis is missed on initial evaluation in up to 38% of patients 2 and is first established at autopsy in up to 28%. 2,3 Clinical manifestations of spinal cord involvement in patients with AD comprise anterior spinal cord syndrome as happened in our case, as well as transverse myelitis with complete spinal cord infarction, Brown-Sequard syndrome, progressive myelopathy or transient spinal cord ischemia. 1,2,5 The clinical profile of our patient consisted of an abrupt, painless and rapid development of anterior spinal cord syndrome.…”

Section: Commentmentioning

confidence: 52%

“…2,3 Clinical manifestations of spinal cord involvement in patients with AD comprise anterior spinal cord syndrome as happened in our case, as well as transverse myelitis with complete spinal cord infarction, Brown-Sequard syndrome, progressive myelopathy or transient spinal cord ischemia. 1,2,5 The clinical profile of our patient consisted of an abrupt, painless and rapid development of anterior spinal cord syndrome. 2,5 Immediate magnetic resonance imaging findings on T1 and T2 wi concomitantly indicated dissection of the descending aorta 1,2 and early ischemic changes of the lower TH spinal cord.…”

Section: Commentmentioning

confidence: 52%

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Acute paraplegia in painless aortic dissection. Rich imaging with poor outcome

et al. 2009

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Study design: Case report. Objective: To describe the clinical and imaging findings of a patient with painless aortic dissection. Setting: University Neurology Department, Thessaloniki, Greece. Patient, Methods, Results: A 46-year-old man was transferred to our Department for emergent evaluation of paraplegia, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, bilateral leg weakness, 24 h earlier. He presented complete flaccid paraplegia with urinary retention, loss of pain and temperature sensation below the TH7 level and wellpreserved vibration and position sense bilaterally. He had no pain and general physical examination was unremarkable. Chest X-rays first raised the suspicion of an aortic lesion. Thoracic MRI revealed cord dilation, with no enhancement on T1-weighted images (wi) and increased signal on T2-wi at the TH9-TH12 levels, suggesting cord ischemia. At the same MR sequences, the double lumen of the descending aorta indicated dissection in both sagittal and axial images. Later the same day, the patient died, and autopsy verified dissection of the descending aorta up to the aortic valve. Conclusion: The rapid evolution of our case further points out that radiologists, neurologists, as well as internal specialists should be vigilant for this emergency, which despite rich imaging could have a fatal outcome. Case reportA 46-year-old man was admitted to the local hospital of a nearby town, complaining for sudden, painless, bilateral leg weakness while defecating, on October 29. There was no family history of any disease and his past medical history disclosed ankylosing spondyloarthritis (positive HLA B27) diagnosed 20 years ago and hypertension treated for the last 2 years. An urgent brain and lumbar spine CT scan was unremarkable and he was transferred to our Department for further evaluation the next day.Neurologically the patient was alert, fully oriented with normal cranial nerves, upper limbs strength and reflexes. He presented complete flaccid paraplegia with urinary retention, absent plantar and deep tendon reflexes, a spinothalamic thoracic (TH) sensory level at TH7 with loss of pain and temperature sensation below this level, extending over the trunk and both lower limbs. However, he had wellpreserved vibration and position sense bilaterally. He was afebrile and complained of no pain, the electrocardiogram was normal, his arterial blood pressure was 140/80 mm Hg, heart rate 82 min À1 with sinus rhythm and no murmurs or other findings were found on general physical examination.Chest X-rays showed mediastinal enlargement first raising the suspicion of an aortic lesion. Complete blood count and routine serum biochemistry provided normal results, except for increased enzymes LDH 714 U l À1 (normal range 240-480), SGOT 95 U l À1 (range 0-38) and CPK 2866 U l À1 (range 0-190). Emergent lumbar puncture in the lateral decubitus position provided normal cerebrospinal fluid opening pressure (160 mm H 2 O) and cytochemistry (clear, no cells protein 45 mg p...

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Section: Commentmentioning

confidence: 52%

Section: Commentmentioning

confidence: 52%

Acute paraplegia in painless aortic dissection. Rich imaging with poor outcome

et al. 2009

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“…[4] Fever, chest pain and back pain are common. Thrombus formation can lead to embolization to peripheral or cerebral vasculature.…”

Section: Discussionmentioning

confidence: 99%

“…Coronary syndromes and aortic valve insufficiency can occur in proximal aortic root involvement. [3,4] Large mycotic aneurysms compress surrounding structures with associated symptoms. Dissection of the aorta and rupture can precipitate cardiopulmonary collapse.…”

Section: Discussionmentioning

confidence: 99%

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Staphylococcal thoracic aortitis complicated by aortic dissection

Lim¹,

Lee²,

Chua³

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND:The diagnosis of aortitis is often delayed as symptoms are largely non-specific. We report a case of Staphylococcal thoracic aortitis in a 73-year-old Chinese woman complicated by aortic dissection.METHODS:The patient presented with pyrexia of unknown origin, and a contrast enhanced computed tomography aortogram revealed a large thrombus at the anterior aspect of the ascending aorta with two large ulcerations as a result of a chronic type A aortic dissection. A hemiarch replacement with a 28 mm Gleweave Vascutek graft was performed with resuspension of aortic valve commisures. Aortic thrombus cultures were positive for coagulase negative Staphylococcus aureaus, and histology showed chronic dissection of the aorta.RESULTS:The patient was treated with intravenous cefazolin for a 6-week duration and made good progress.CONCLUSIONS:This case highlights Staphylococcal infective aortitis complicated by dissection presenting as fever of unknown origin. Timely diagnosis is essential as progression to catastrophic rupture may occur.

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Association of Angiotensin II Type 1 Receptor Agonistic Autoantibodies With Outcomes in Patients With Acute Aortic Dissection

Cheng

et al. 2021

JAMA Netw Open

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IMPORTANCE Angiotensin II is significantly associated with the pathogenesis of acute aortic dissection. Angiotensin II type 1 receptor agonistic autoantibodies (AT1-AAs) can mimic the effect of angiotensin II.OBJECTIVE To investigate the association between AT1-AAs and all-cause and cause-specific mortality risk in patients with acute aortic dissection. DESIGN, SETTING, AND PARTICIPANTSA total of 662 patients with clinically suspected aortic dissection from 3 medical centers in Wuhan, China, were enrolled in this cohort study from August 1, 2014, to July 31, 2016. Of these, 315 patients were included in the 3-year follow-up study. Follow-up was mainly performed via telephone interviews and outpatient clinic visits. Data analysis was conducted from March 1 to May 31, 2020. MAIN OUTCOMES AND MEASURESThe primary outcomes of interest were all-cause mortality, death due to aortic dissection, and late aortic-related adverse events. RESULTSThe full study cohort included 315 patients with AAD (mean [SD] age, 56.2 [12.7] years; 230 men [73.0%]). Ninety-two patients (29.2%) were positive for AT1-AAs. The mortality of AT1-AApositive patients was significantly higher than that of AT1-AA-negative patients (40 [43.5%] vs 37 [16.6%]; P < .001). The mortality risk in AT1-AA-positive patients was always significantly higher than that in AT1-AA-negative patients in patients with both type A and type B dissection. Multivariable analysis showed that the risk of AT1-AA-positive patients for type A dissection was significantly higher than that of AT1-AA-negative patients (odds ratio [OR], 1.88; 95% CI, 1.12-3.13; P = .02). The Cox proportional hazards regression model showed a significant increase of all-cause mortality risk (OR, 2.27; 95% CI, 1.44-3.57; P < .001) and late aortic-related adverse events (OR, 1.58; 95% CI, 1.06-2.36; P = .03) among AT1-AA-positive patients during the follow-up period compared with AT1-AAnegative patients.CONCLUSIONS AND RELEVANCE This cohort study first detected AT1-AAs in patients with acute aortic dissection. The presence of AT1-AAs was associated with significantly higher all-cause and cause-specific mortality during a follow-up period of 3 years. The antibodies may be a risk factor for aortic dissection.

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Clinical, Diagnostic, and Management Perspectives of Aortic Dissection

Cited by 520 publications

References 152 publications

Acute paraplegia in painless aortic dissection. Rich imaging with poor outcome

Acute paraplegia in painless aortic dissection. Rich imaging with poor outcome

Staphylococcal thoracic aortitis complicated by aortic dissection

Association of Angiotensin II Type 1 Receptor Agonistic Autoantibodies With Outcomes in Patients With Acute Aortic Dissection

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