Fever Associated With Acute Aortic Dissection

Abstract

cute aortic dissection presents with various symptoms; that is, pain, nausea, vomiting, hematemesis, cold sweat, syncope, cerebrovascular accident, ischemic peripheral neuropathy, hypertension, congestive heart failure, shock, cardiac arrest, and sudden death. In addition, fever is often associated with acute aortic dissection and in rare cases is persistent so that it becomes difficult to determine whether or not it is associated with acute aortic dissection. A number of such cases have been reported, 1-4 as well as those in which aortic dissection was identified as the cause of an initially unexplained fever. [5][6][7][8][9][10] However, the duration of fever associated with acute aortic dissection is not well known, so the present study was undertaken to investigate the duration of fever associated with acute aortic dissection and to examine the relationship between duration and hematological parameters and reduction in false lumen size. Methods SubjectsDuring the 26-year period from January 1978 to December 2003, 336 patients with acute aortic dissection were admitted to Kinki University Hospital. Of these 57 meeting the following requirements were selected: (1) hospitalization within 1 week after disease onset, (2) treated medically rather than surgically, (3) judged free of infection, ileus, acute renal failure, malignant tumor, collagen disease, drug allergy, etc and (4) followed for 1 month after disease onset. Diagnosis of DissectionContrast-enhanced computed tomography (CT) scans were used to make a definitive diagnosis of aortic dissection. FeverAxillary body temperatures were measured and the highest temperature during the day was considered the body temperature for that day. A diagnosis of fever was made if body temperature was over 37°C. The duration of fever was defined as the period from the onset of fever to the last day on which body temperature was over 37°C during the 1-month follow-up period.The mean duration of fever was calculated for the entire study population. The patients were then divided into 2 groups: those with duration of fever shorter than the mean (Group A: brief fever group) and those with duration of fever equal to or longer than the mean (Group B: extended fever group). Hematological parameters and reduction in false lumen size were compared between these groups. Reduction in False Lumen SizeContrast-enhanced CT images, obtained at admission and 1 month later, were fed into a computer to determine the false lumen reduction ratio, as shown in Fig 1. HematologyWhite blood cell (WBC) and platelet counts, and C-reactive protein (CRP), fibrinogen, fibrin degradation product (FDP), D-dimer, and thrombin -antithrombin III complex (TAT) concentrations were compared between groups. Mean values for the WBC and platelet counts and CRP concentration were calculated for each week, and changes were analyzed at 1, 2, 3 and 4 weeks after admission. For fibrinogen, FDP, D-dimer, and TAT, the means weeks 1-2 and weeks 3-4 were analyzed.Circ J 2007; 71: 766 -771 (Received September 4, 2006; ...

Fibrinogen/Fibrin Degradation Products in Acute Aortic Dissection

“…Therefore, these 2 biomarkers may be useful in more practical applications. In addition, there have been 4 previous reports that address elevated FDP values in patients with aortic dissection (14)(15)(16)(17), but none of these reports compared the FDP values at the time of patient admission between patients with AAD and control subjects to reveal the usefulness of FDP in diagnosing patients with AAD. Therefore, to the best of our knowledge, this is the first report that has demonstrated sensitivity and negative predictive values of FDP in the initial assessment of AAD, suggesting that the measurement of FDP may be an alternative tool for the measurement of D-dimer levels.…”

Chronic Stanford type A aortic dissection manifesting as systemic inflammatory disorder

“…[3][4][5][6][7][8] Of interest, while febrile reaction at presentation of acute aortic dissection is a well-known feature of the disease, chronic aortic dissection in which fever or other symptoms of systemic illness dominate the clinical picture for weeks is distinctly rare, with diagnosis usually made by imaging modalities incidentally in the course of basic investigation. 9,10 The presence of small left sided pleural effusion has been mentioned as a clue for the right diagnosis in this setting. 11,12 The pathogenetic mechanisms of the prolonged systemic response in the course of chronic aortic dissection have not been elucidated yet.…”

Fever after Percutaneous Endovascular Stent-graft in Type B Acute Aortic Dissection

“…The present study showed that 85.9% patients with acute aortic dissection had fever after stent, in whom about one-fourth of the patients already had fever the day before stent, which suggested that stent-graft could increase the possibility of fever. The fever associated with aortic dissection involves an inflammatory reaction, which is caused by thrombi, destroyed tissue, and cytokines (7). False lumen thrombosis is the main pathophysiological feature after stent-graft in acute aorta dissection.…”

“…Only two papers have been published concerning the characteristics of fever associated with acute aortic dissection (7,8). However, the beginning time and duration of fever after percutaneous endovascular stent-graft in patients with aortic dissection is not well known.…”