Rupture of an aortic dissection into the pericardium

Patel, Yashwant D.

doi:10.1007/bf02577947

Cited by 6 publications

(8 citation statements)

References 9 publications

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“…Lung cancer can result in tamponade via metastatic pericardial or cardiac involvement (60). Aortic pathologic conditions that can result in tamponade include aortic dissection and aneurysm rupture (34,61,62) (Fig 22). Mediastinal pathologic conditions that can cause tamponade include mediastinal malignancy producing direct cardiac compression, such as lymphoma or small cell lung cancer.…”

Section: Specific Causes Of Pericardial Tamponade As Demonstrated At Ctmentioning

confidence: 99%

Imaging Findings in Cardiac Tamponade with Emphasis on CT

Restrepo¹,

Lemos²,

Lemos³

et al. 2007

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Cardiac tamponade is a life-threatening condition that results from slow or rapid heart compression secondary to accumulation of fluid, pus, blood, gas, or tissue within the pericardial cavity. This condition can be associated with multiple causes including trauma, inflammation, scarring, or neoplastic involvement of the pericardial space among others. The main pathophysiologic event leading to tamponade is an increase in intrapericardial pressure sufficient to compress the heart with resultant hemodynamic impairment, which leads to limited cardiac inflow, decreased stroke volume, and reduced blood pressure. These events result in diminished cardiac output, which manifests clinically as a distinctive form of cardiogenic shock. Although cardiac tamponade is a clinical diagnosis, imaging studies play an important role in assessment and possible therapeutic intervention. Computed tomographic (CT) findings associated with cardiac tamponade include pericardial effusion, usually large, with distention of the superior and inferior venae cavae; reflux of contrast material into the azygos vein and inferior vena cava; deformity and compression of the cardiac chambers and other intrapericardial structures; and angulation or bowing of the interventricular septum. Familiarity with the clinical and pathophysiologic features of cardiac tamponade and correlation with the associated CT findings are essential for early and accurate diagnosis.

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Section: Specific Causes Of Pericardial Tamponade As Demonstrated At Ctmentioning

confidence: 99%

Imaging Findings in Cardiac Tamponade with Emphasis on CT

Restrepo¹,

Lemos²,

Lemos³

et al. 2007

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170

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“…Hypotension and shock in patients with aortic dissections are caused by acute severe aortic regurgitation, aortic rupture, cardiac tamponade, or left ventricular systolic dysfunction. 47,48 A rupture or leak of the dissection process into the pericardial cavity may result in acute pericardial effusion/cardiac tamponade and death. 48 Nevertheless, in most cases of aortic dissection, the development of a pericardial effusion is not secondary to the rupture or leak of the dissection into the pericardial cavity, rather it is due to the transudation of fluid into the pericardial cavity through the intact wall of the false lumen.…”

Section: Manifestations Secondary To Organ System Involvementmentioning

confidence: 99%

Clinical, Diagnostic, and Management Perspectives of Aortic Dissection

Khan

Nair

2002

Chest

520

411

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“…In the ascending thoracic aorta, the primary tear is most often within 3 cm of the aortic cusps. 2 The false lumen of aorta may rupture due to loss of elastic recoil and increased wall stress with dilatation. Often, the rupture site is close to the initial intimal-medial tear over the right lateral wall where it receives the ejected blood from the left ventricle.…”

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confidence: 99%

“…Often, the rupture site is close to the initial intimal-medial tear over the right lateral wall where it receives the ejected blood from the left ventricle. 2 This ends up into the pericardial sac causing haemopericardium and subsequent fatal cardiac tamponade. 2 Computed tomography aortogram is the firstline modality in the diagnosis of aortic dissection, delineation of its extent of involvement and endorgan ischaemia.…”

mentioning

confidence: 99%

“…2 This ends up into the pericardial sac causing haemopericardium and subsequent fatal cardiac tamponade. 2 Computed tomography aortogram is the firstline modality in the diagnosis of aortic dissection, delineation of its extent of involvement and endorgan ischaemia. In our case, rupture of the aorta into the pericardial sac was evidenced by significant contrast-enhanced haemopericardium on CT aortogram images which was absent in pre-contrast CT images.…”

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Sudden cardiac arrest with pericardial contrast during computed tomography aortogram in a type A aortic dissection patient

Wong

2019

Hong Kong Med J

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A 69-year-old man with long-standing hypertension and history of pulmonary embolism on warfarin presented to Accident and Emergency Department with sudden upper back pain and transient loss of consciousness. On admission, the patient was in haemodynamic shock with blood pressure 83/57 mm Hg and pulse 42 beats per minute. Cardiovascular examination revealed radial-radial and radialfemoral delay. Electrocardiogram showed complete heart block and chest radiograph demonstrated a widened mediastinum. An immediate bedside echocardiogram found an intimal flap in the aortic root with evidence of aortic regurgitation and a thin rim of pericardial effusion.Fluid resuscitation and inotropic support was given and urgent computed tomography (CT) aortogram was arranged to further delineate the extent of involvement of aortic dissection. However, the patient developed sudden cardiac arrest immediately after being given 80 mL intravenous Omnipaq at a rate of 3 mL/s via injector during CT aortogram. A review of CT images showed Stanford type A aortic dissection with an intimal flap extending into the pericardial sac (Fig 1). No obvious pericardial effusion was visible on the pre-contrast CT images (Fig 2a). However, significant contrast was seen in the pericardial sac on post-contrast CT images (Fig 2b), indicating a sudden rupture with haemopericardium had occurred during the CT scan. Despite prompt bedside pericardiocentesis and cardiopulmonary resuscitation, the patient died.Aortic dissection is the most common acute emergency condition of the aorta. The mortality rate is high, and rupture is the cause of death in approximately one-third of affected patients. 1 The pathology is due to a tear in the intimal layer allowing blood to propagate into the media and create a false lumen. In the ascending thoracic aorta, the primary tear is most often within 3 cm of the aortic cusps. 2 The false lumen of aorta may rupture due to loss of elastic recoil and increased wall stress with dilatation. Often, the rupture site is close to the initial intimal-medial tear over the right lateral wall where it receives the ejected blood from the left ventricle. 2 This ends up into the pericardial sac causing haemopericardium and subsequent fatal cardiac tamponade. 2 Computed tomography aortogram is the firstline modality in the diagnosis of aortic dissection, delineation of its extent of involvement and endorgan ischaemia. In our case, rupture of the aorta into the pericardial sac was evidenced by significant contrast-enhanced haemopericardium on CT aortogram images which was absent in pre-contrast CT images. This could be related to the rapid injection of a large volume bolus of intravenous contrast by power-injector, resulting in a sudden elevation of left ventricular pressure, supported by PICTORIAL MEDICINE FIG 2. (a) Pre-contrast computed tomography image showing normal pericardium. (b) Computed tomography aortogram image showing significant contrast in the pericardium. A dissection flap can be seen within the descending thoracic aorta. The fal...

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Rupture of an aortic dissection into the pericardium

Abstract: This case report illustrates the angiographic demonstration of a hemopericardium in aortic dissection. A dense collection of contrast and/or a "halo" sign may be seen in the pericardial cavity.

Cited by 6 publications

References 9 publications

Imaging Findings in Cardiac Tamponade with Emphasis on CT

Imaging Findings in Cardiac Tamponade with Emphasis on CT

Clinical, Diagnostic, and Management Perspectives of Aortic Dissection

Sudden cardiac arrest with pericardial contrast during computed tomography aortogram in a type A aortic dissection patient

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