Seeing the invisible: painless aortic dissection in the emergency setting

Ayrık, Cüneyt

doi:10.1136/emj.2004.021790

Cited by 44 publications

(27 citation statements)

References 7 publications

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“…However, the detection of image compatible with blood inside the left pleural space (hemothorax) in the transthoracic echocardiogram was strong evidence for the diagnosis of thoracic aortic rupture. This is one of the major differential diagnoses for patients with non-traumatic hemothorax, with mortality exceeding 90% [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Hemoptise e hemotórax como apresentação de ruptura de aorta torácica

Lima¹,

Vieira²

2009

Rev Bras Cir Cardiovasc

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Thoracic aortic dissection is a disease of great mortality in its initial phase, but in some cases it can assume chronic course. We report a case of a patient with Stanford type A1 aortic dissection, admitted with mental confusion, dyspnea and event of severe hemoptysis. Electrocardiogram showed unspecific change and chest X-ray revealed opacification of the left hemithorax. Transthoracic echocardiogram did not show aortic dissection, but showed image similar to hemithorax leading to the suspicion of aortic rupture. The patient developed cardiovascular collapse and evolved to death. This case describes two unusual presentations of aortic dissection: hemothorax and severe hemoptysis.Descriptors: Aneurysm, dissecting/surgery. Aortic aneurysm, thoracic/complications. Hemothorax. Fistula. Echocardiography. ResumoDissecção da aorta torácica é doença de grande mortalidade em sua fase inicial, mas pode, em alguns casos, se cronificar. Relatamos caso de paciente com dissecção crônica de aorta tipo B (Stanford), admitido na Emergência com confusão mental, dispnéia e relato de hemoptise importante. O eletrocardiograma mostrava alterações inespecíficas e a radiografia de tórax revelou opacificação do hemitórax esquerdo. O ecocardiograma transtorácico não evidenciou dissecção aórtica, mas demonstrou imagem compatível com hemotórax, ocasionando a suspeita de ruptura da aorta. O paciente evoluiu em colapso cardiovascular e óbito. Este caso descreve duas apresentações atípicas da dissecção de aorta: hemotórax e hemoptise importante.Descritores: Aneurisma dissecante/cirurgia. Aneurisma da aorta torácica/complicações. Hemotórax. Fístula. Ecocardiografia.

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Section: Discussionmentioning

confidence: 99%

Hemoptise e hemotórax como apresentação de ruptura de aorta torácica

Lima¹,

Vieira²

2009

Rev Bras Cir Cardiovasc

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“…Auch wenn Brustschmerzen, wie in der vorliegenden Untersuchung, mit abruptem Beginn und starker Ausprägung das häufigste klinische Symptom darstellen [2,3,7,9,10,15], sind asymptomatische schmerzlose Aortendissektionen bei 5-20% der Patienten beschrieben [8,9,16,17] [22]. Auch können gelegentlich ein Aneurysma dissecans und ein Myokardinfarkt zusammen auftreten [7].…”

Section: Diagnostikunclassified

Aneurysma dissecans – keine so seltene Erkrankung

et al. 2010

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Key in the management of acute aortic dissection is to maintain a high clinical index of suspicion for this diagnosis. Etiologically hereditary diseases (Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome) should be taken into consideration as a possible cause. In all unexpected deaths of young adults an autopsy should be performed to detect the cause of death and for genetic testing to provide information for the relatives in case an aortic aneurysm can be found.

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“…5 Painless AAD has been also reported. 6,7 There are three major classification system for aortic dissection depending on it's location and extent of aortic involvement. These are (1) DeBakey types I, II and III; (2) Stanford types A and B and (3) The anatomical categories proximal and distal (Fig.…”

Section: Introductionmentioning

confidence: 99%

A Case of Complicated Acute Type B Aortic Dissection

Chowdhury

Ghafoor

Salauddin

et al. 2015

Anwer Khan Mod Med Coll J

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A 60-years old hypertensive lady was referred to our hospital with suspected acute coronary syndrome with the complaints of shortness of breath for one day and abdominal pain for 2 days. Pain started at upper abdomen and lower chest, intense and sharp in nature radiated to lower abdomen and back. Initially she was admitted in a hospital as acute abdomen (Acute pancreatitis). Next day she developed respiratory distress and referred to our hospital. On examination her blood pressure was 180/100 mmHg and pulse 88 beat per minute. She had epigastric tenderness and on auscultation of lungs bilateral basal crepitation with rhonchi .Remainder of physical examination was unremarkable. Lab results showed mild anaemia, other results including amylase, lipase and cardiac markers were within normal limit. ECG showed T inversion in precordial and inferior leads. Her echocardiogram revealed absence of regional wall motion abnormality with good LV systolic function but there was mild pericardial and left sided plural effusion with suspected dissection of descending thoracic aorta from origin of IntroductionAcute aortic dissection (AAD) is a medical emergency which without appropriate treatment has 75% mortality within 2 weeks of the disease onset. 1 It usually presents with severe chest pain of sudden onset which without proper clinical evaluation and diagnostic imaging may be confused with acute myocardial infarction or pulmonary embolism and treated with drugs (Antithrombotic and anticoagulants) which are contraindicated in AAD. Some times pain may migrate to back if the dissection extends down the aorta. Less commonly the sign & symptoms are due to organ hypoperfusion and include peripheral ischemic syndromes, syncope, myocardial infarction or neurological symptoms. 2-4 Symptoms may occur due to organ compression by an expanding haematoma (e.g dyspnea by tracheal or bronchus compression, dyshagia by esophageal compression or hoarseness by laryngeal nerve compression). 5 Painless AAD has been also reported. 6,7 There are three major classification system for aortic dissection depending on it's location and extent of aortic involvement. These are (1) DeBakey types I, II and III; (2) Stanford types A and B and (3) The anatomical categories proximal and distal (Fig. 1). The basic principal of all these system of classification is for distinguishing aortic dissections with or without ascending aorta involvement as therapeutic approach and clinical outcome is determined by its involvement. Usually surgery is indicated if ascending aorta is A Case of Complicated Acute Type B Aortic Dissection

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Seeing the invisible: painless aortic dissection in the emergency setting

Cited by 44 publications

References 7 publications

Hemoptise e hemotórax como apresentação de ruptura de aorta torácica

Hemoptise e hemotórax como apresentação de ruptura de aorta torácica

Aneurysma dissecans – keine so seltene Erkrankung

A Case of Complicated Acute Type B Aortic Dissection

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