Type A Aortic Dissection Presenting as Acute Coronary Syndrome in a Young Male Patient: A Case Report

Abstract

Type A aortic dissection (AD) is a devastating cardiovascular emergency requiring emergent surgical intervention. Most patients with AD have several risk factors for the disease including longstanding hypertension, smoking history, atherosclerosis, and old age. Younger patients may also present with AD if a genetic disorder affecting the integrity of the aorta is present. This case presents an otherwise healthy 36year-old male with no known significant family history who presented with an atypical presentation of aortic dissection. He described a five-day history of chest pressure made worse with exertion followed by progressive dyspnea which prompted him to seek medical attention. His initial laboratory workup revealed an elevated troponin I level which prompted a cardiology consultation in the emergency department. Transthoracic echocardiography revealed dilatation of the aortic root and aortic regurgitation. CT angiography of the chest was performed revealing a type A dissection beginning at the aortic root and terminating proximal to the right brachiocephalic artery. Involvement of the coronary arteries was suspected due to the elevated troponin I. He was taken to the operating room and underwent aortic grafting, right coronary artery bypass, and repair of the left main artery. Unfortunately, at the end of the operation, the patient went into refractory ventricular fibrillation, which progressed to asystole. He was unable to be revived.

Chilaiditi's sign in complicated acute appendicitis: case report and literature review

“…On the other hand, Chilaiditi syndrome occurs in the presence of associated clinical manifestations such as chest pain, abdominal pain and related complications. 2,3 Chilaiditi's condition should be differentiated from pneumoperitoneum, a condition that has different implications for patient management, as Chilaiditi's sign does not require acute surgical management. 2,4 Most cases present without associated symptoms.…”

“…2,4 Most cases present without associated symptoms. 3 This condition is described as being more common in men and in those over 60 years of age. 5 The etiology may be acquired or congenital and is related to alterations of the falciform ligament, malrotation or paralysis of the diaphragm.…”

“…Conditions such as liver cirrhosis, decreased liver size, obesity and a history of colonoscopy may predispose to this condition. 3,5 Clinical manifestations vary from an asymptomatic course and Chilaiditi's sign as an incidental finding to manifestations of intestinal occlusion, cecal or transverse colon volvulus and alterations in respiratory mechanics. 5 Radiographic imaging studies can demonstrate the existence of a haustra below the diaphragm or simulate pneumoperitoneum.…”

“…The accuracy of this sign is obtained through computed tomography, which allows the identification of the interposed colon and the exclusion of pathologies that require immediate surgical resolution. 3 It must be differentiated from other pathologies such as diaphragmatic hernia, pneumoperitoneum and hepatic abscesses. 6 To be able to establish Chilaiditi's sign, imaging must show the right hemidiaphragm elevated by the colon interposed over the liver, distension of the colon with gas simulating pseudo pneumoperitoneum, and depression of the hepatic rim by the overlying colon.…”