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PubMedDate not supplied

Ruptured thoracic aortic dissection presenting as opacified left hemothorax.

Acute aortic dissections are uncommon, with a reported incidence of 2000 cases per year in the United States. Hemothorax is an unusual but well-described complication of ruptured thoracic aortic dissection. It usually occurs on the left and can be seen in both proximal and distal dissections. Chest radiographs (CXR) in thoracic aortic dissections often reveal a widened mediastinum or abnormal aortic silhouette, evident in 80%-90% of cases. However, CXR may be normal in about 12% of patients with aortic dissection. Clues that would indicate aortic dissection such as abnormal aortic silhouette and widened mediastinum may be obscured by an opacified hemothorax caused by rupture of a thoracic aortic dissection. A high index of suspicion is necessary to make a diagnosis of ruptured thoracic aortic dissection in a patient presenting with hemothorax. This is illustrated in the case described.

Aged↗
PubMedDate not supplied

"Hyperdense" aortic wall: potential pitfall in CT screening for aortic dissection.

Opacity of the aortic wall as compared with the nonopacified blood in the lumen has been utilized as one of the criteria for the diagnosis of aortic dissection. It has also been suggested that this finding may be indicative of severe anemia. We evaluated the frequency and implications of aortic wall hyperdensity in 107 consecutive chest CT examinations in patients with no indication of aortic dissection clinically or by other imaging modalities, and whose hematocrit was known. The density of the wall correlated with the patient's age and presence of calcification. Presence or absence of anemia was not a statistically significant factor, although marked conspicuousness of the wall below the age of 60 years did suggest anemia. Atherosclerosis is the most likely explanation for wall visibility in nonanemic patients.

Aortic Dissection↗
PubMed1986

Aortic dissection in adolescence.

Although aortic dissection is rare in children, it does occur, particularly in those with congenital heart disease, connective tissue disorders or severe trauma. Prompt diagnosis is essential. Aortic dissection should be considered in children and adolescents with severe abdominal pain, especially pain that migrates. The patient is often much more uncomfortable than can be explained on the basis of physical findings. Criteria have been established for choosing medical or surgical therapy.

Abdomen↗
PubMed1999

Utility of contrast echocardiography in the diagnosis of aortic dissection.

Determination of ascending aortic involvement in aortic dissection has significant implications in prognosis, immediate surgical referral, and surgical approach. We report 2 cases of the use of an echo contrast agent in enhancing the diagnostic capability of transesophageal echocardiography in suspected ascending aortic dissection. Contrast echocardiography eliminated the linear artifacts often confused with true dissection flaps and allowed easy identification of the presence of true and false lumina.

Aged↗
PubMed1994

Unilateral absence of right-lung perfusion with normal ventilation on radionuclide lung scan as a sign of aortic dissection.

A case of aortic dissection with unilateral absence of right-lung perfusion and normal ventilation on radionuclide ventilation/perfusion (V/Q) lung scan is presented with a review of the literature. Anticoagulation or thrombolytic therapy for presumed pulmonary embolism may be catastrophic if the clinical syndrome and V/Q scan appearance are instead due to aortic dissection. With this V/Q scan appearance, these therapies should not be instituted unless pulmonary embolism is diagnosed by pulmonary arteriography.

Aortic Dissection↗
PubMed1996

[A case of acute thrombosed aortic dissection (Stanford type A) in association with a true aortic arch aneurysm].

We have experienced a rare case of Stanford type A thrombosed aortic dissection in association with true aortic arch aneurysm. A 73-year-old male with asymptomatic true aortic arch aneurysm had sudden onset of severe back pain. A through examination clarified that he had Stanford type A aortic dissection coexisting with true aneurysm. In operation, we found a tear on intima of the proxymal-part of the true aneurysm. Pathologically, dissection confined to the ascending aorta did not involve the true aneurysm. The replacement of ascending aorta and aortic arch was successfully accomplished. The combination of true aortic arch aneurysm and Stanford type A aortic dissection is rare bibliographically.

Acute Disease↗
PubMed1978

Diagnosis of dissecting aortic aneurysm with suprasternal echocardiography.

A 33 year old woman with Marfan's syndrome and aortic root dissection was studied with precordial and suprasternal echocardiography. The precordial approach revealed some typical features of aortic root dissection. With suprasternal echocardiography it was possible to visualize the characteristic diagnostic feature of this disease: within the aortic lumen an m-shaped pattern--the aortic intimal flap--moving downward to the posterior aortic wall during systole. The diagnosis was confirmed with aortic cineangiography and intraoperative findings. Thus, suprasternal echocardiography can be a useful method of detecting aortic root dissection, especially in patients with aortic arch dissection alone.

Adult↗
PubMed1999

Aortic dissection: A "humerus" case.

Aortic dissection usually presents with acute onset of severe chest pain. Classically there is a pressure differential between the 2 arms and widening of the mediastinum. Echocardiography is considered the investigation of choice in many institutions. A case is presented in which the presentation and clinical signs are classical for dissection. Transthoracic echocardiography demonstrated "enlargement" of the descending aorta and a "flap." A surprise diagnosis was made by transesophageal echocardiography. Other vascular structures in the para-aortic regions should be considered when the diagnosis of aortic dissection is entertained.

Aortic Dissection↗
PubMed1987

[Coronary insufficiency in type II aortic dissection].

After coronary sclerosis, aortic dissection represents an important differential diagnosis in the evaluation of acute thoracic pain. We report on a 55-year-old patient with aortic dissection, type II, in whom the diastolic collapse of the true aortic lumen was verified by angiography and transesophageal echocardiography. The collapse led to a temporary perfusion deficit of the left coronary artery with clinical symptoms and ECG changes. Clinical symptoms, additional diagnostic procedures and follow-up of this patient, as well as the value of transesophageal echocardiography, are presented.

Aortic Dissection↗
PubMed2002

Intraoperative aortic dissection--a case report.

Intraoperative aortic dissection is a rare but potentially fatal complication of cardiac surgery. Prompt recognition and repair are necessary to limit the extent of dissection to minimize morbidity and mortality. Here, we present a case of acute type A dissection of ascending aortic artery occurring after removal of aortic cannula at the end of cardiopulmonary bypass. The surgeon immediately recannulated him at the femoral artery and repaired the dissection under deep hypothermia. Ascending aorta was replaced with Hemashield graft and venous graft was reimplanted. Unfortunately, the patient expired the following day due to cardiac tamponade resulting from uncontrolled bleeding. Long-standing severe hypertension, severe atherosclerotic change of the aortic wall, thin and dilating ascending aorta and cystic medial necrosis or collagen vascular disease were thought to predispose him to this complication. Gentle manipulation and surgical discreetness to forestall aoratic injury could minimize the risk of intraoperative aortic dissection. Once aortic dissection has been suspected, prompt application of transesophageal echocardiography to confirm the diagnosis, and rapid as well as appropriate surgical management are necessary to grasp a better outcome.

Aged↗
PubMed1996

Acute aortic dissection with intramural hematoma: possibility of transition to classic dissection or aneurysm.

Acute aortic dissection with intramural hematoma has been believed to have a good prognosis, but we have encountered the transition of this entity to a classic dissection or aneurysm. We report the serial computed tomography (CT) features in 27 cases of acute aortic dissection with intramural hematoma. Eleven patients (40.7%) developed a classic dissection or aneurysm during follow-up. Four patients (14.8%) showed transition to a classic dissection without resolution of the intramural hematoma; each had a dilated ascending aorta measuring > 5 cm in diameter on the initial CT. One case (3.7%) developed an enlarging aneurysm without resolution of the intramural hematoma. In 19 cases (70.4%), the hematoma resolved; among these 19, the aortic diameter was significantly larger (p < 0.01) than those in a normal control group. Two of these 19 later developed an aneurysm, and four developed a classic dissection. This entity often (40.7%; 11 of 27) required surgical intervention or periodic follow-up CT examinations, particularly with a dilated ascending aorta of > 5 cm in diameter.

Acute Disease↗
PubMed1997

Coagulopathy associated with residual dissection after surgical treatment of type A aortic dissection.

PURPOSE: This study was performed to evaluate the effects of a residual dissection on coagulation, fibrinolysis, and platelet function after surgical treatment of acute type A aortic dissection. METHODS: Between 1987 and 1995, 48 consecutive patients underwent emergency surgery for acute type A aortic dissection. Thirty-five of 41 survivors were followed-up for periods ranging from 6 to 112 months (median, 30.3 months). These survivors were classified into three groups by computed tomographic scanning and angiography. Fifteen patients had no residual dissection (group I). Of the 20 patients who had residual dissection, nine had an enlarged aorta greater than 45 mm in maximal diameter (group II), and 11 had an aorta less than 45 mm in maximal diameter (group III). For all patients, blood samples were collected for coagulation, fibrinolysis, and platelet function studies on the same day that the computed tomographic scanning had been performed. RESULTS: beta-thromboglobulin, thrombin-antithrombin III complex, D-dimer, and alpha 2 plasmin inhibitor-plasmin complex concentrations were significantly higher in group II than in the other two groups. Strong correlations between the maximal diameter of the dissected aorta and beta-thromboglobulin, thrombin-antithrombin III complex, D-dimer, and plasmin inhibitor-plasmin complex concentrations were evident. In contrast, correlations between the length of the dissected aorta and coagulation/fibrinolysis measurements were weak. CONCLUSIONS: Our findings suggest that the coagulopathy worsened in proportion to the degree of dilatation of the dissected aorta.

Acute Disease↗
PubMed1999

Type A aortic dissection involving a right-sided aortic arch.

We report a rare case of a 39-year-old man with type A aortic dissection involving a right-sided aortic arch with the symptom of vascular ring. Computed tomography scanning and angiography were performed to define the extent of the dissection and the anatomy of the branching vessels. The ascending aorta was replaced through a median sternotomy and right thoracotomy using a hypothermic cardiopulmonary bypass associated with selective cerebral perfusion and partial circulatory arrest, and his symptom of vascular ring disappeared postoperatively.

Adult↗
PubMed1993

Replacement of the transverse aortic arch for type A acute aortic dissection.

Surgical treatment of acute aortic dissection involving the segment of transverse aortic arch is difficult and often associated with a high mortality and morbidity. The high mortality and morbidity are primarily related to anatomic features and techniques of cerebral protection employed during the period of aortic branch occlusion needed for reconstruction. This study reports our experience of 20 consecutive cases of acute type A aortic dissection treated by repair or replacement of the transverse aortic arch during emergency operation. Ages of the patients ranged from 56 to 76 years. All patients were referred to us within 2 weeks of onset (mean time, 58 hours). Selective cerebral perfusion or deep hypothermia with complete circulatory arrest was employed during the period of aortic branch occlusion. Duration of cerebral perfusion, circulatory arrest, myocardial ischemia, and cardiopulmonary bypass averaged 106 minutes, 32 minutes, 127 minutes, and 248 minutes, respectively. There were three operative deaths. All three dissections were ruptured ones, and the patients died of hemorrhage, deep coma, or multiple organ failure. One patient died of infection 3 months after operation. The remaining patients are alive and well without any detectable neurological deficit 1 month to 4 years postoperatively. This experience emphasizes that repair or replacement of acute type A aortic dissection involving the aortic arch can be performed safely by adequate selection of patients, supportive measures, and operative methods.

Acute Disease↗