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CT scan with contrast showing a thoracic aortic dissection involving the ascending aorta and descending aorta, with an intramural hematoma in the descending aorta. (a)–(d) show coronal sections at different levels.
Source publication
Aortic dissection is a life-threatening medical emergency often presenting with severe chest pain and acute hemodynamic compromise. The presentation of aortic dissection can sometimes be different thus leading to a challenge in prompt diagnosis and treatment as demonstrated by the following presentation and discussion. We present a case of a 71-yea...
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Introduction:
The purpose of this study was to analyze the difference in clinical and aortic morphological features between the bovine aortic arch and normal aortic arch in patients with acute type B aortic dissection (aTBAD).
Methods:
A total of 133 patients diagnosed with aTBAD were retrospectively collected. Based on aortic arch morphology, t...
Objectives:
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Citations
... Aortic dissection should also be a differential diagnosis in patients with acute onset headache in whom any intracranial source of headache is not found. 8 Prioritizing neurological workup in these cases can cause delay in diagnosis and adverse events. ...
Retrosternal chest pain is the classical symptom of acute coronary syndrome (ACS). ACS sometimes presents with atypical symptoms and very rarely as headache as the only symptom. We present here a case where a patient who had undergone coronary artery bypass grafting presented with headache and on evaluation found to have complete occlusion of right coronary artery.
... Contrast CT of the chest revealed a thoracic AD involving both the ascending and descending aorta, with an intramural hematoma in the descending aorta. The dissection extended superiorly to the brachiocephalic and left common carotid trunks [5]. ...
Aortic diseases cover a large spectrum of conditions, such as aortic aneurysm and acute aortic syndromes (i.e., dissections, intramural hematoma, penetrating atherosclerotic ulcer, traumatic aortic injuries, and pseudoaneurysms), genetic diseases (e.g., Marfan syndrome) and congenital abnormalities, such as coarctation of the aorta. These conditions may have an acute presentation; thus, if the acute aortic syndrome is the first sign of the disease, the prognosis is extremely poor. Prompt diagnosis and timely therapy are therefore mandatory. In this paper, we discuss a deceptive symptom of painless aortic dissection and its physiopathology. Furthermore, we briefly review the literature and discuss the management of diagnostic tools.
要旨
62歳の男性が頭痛を主訴に救急搬送され，入院した。頭痛の性状は雷鳴様頭痛であり，神経学的所見には異常を認めなかった。また胸背部痛の訴えもなかった。頭部CTと頸動脈CT angiographyは異常なく，頭部MRIは両側上眼静脈の著明な拡張を認めた。入院後，右下肢の激痛が出現したため大動脈造影CTを施行したところStanford A型の急性大動脈解離と判明し，血管外科治療のため転院した。本症例は頸動脈解離を伴わずに大動脈解離のみで雷鳴様頭痛を呈した。大動脈解離血管の圧迫による上大静脈症候群のため頭蓋内圧亢進と脳血流自動調節能の破綻を引き起こしたことが，頭痛の原因と推察した。救急外来において非典型的頭痛の鑑別診断に，大動脈解離など重篤な血管障害のスクリーニングを念頭に置き，必ず胸部X線写真を撮影するべきである。
Se describe el caso de un paciente de 70 años que consultó por cefalea súbita, tipo trueno, sin alteración del estado de consciencia, acompañada de dolor torácico de una hora de evolución y de baja intensidad. A su ingreso fue enfocado como cefalea en trueno, que es clasificada, en cuanto a la atención, como bandera roja. La medición de troponina fue negativa y una tomografía de cráneo fue leída como normal. Desde el ingreso presentaba signos vitales normales, cuando iba a ser dado de alta se torna hipotenso (completamente asintomático) y por su síntoma cardinal (cefalea), que se asoció a dolor torácico leve y no anginoso, se solicitó angiotomografía toracoabdominal, con la que se demostró aneurisma disecante de la aorta. Con la presentación de este caso, se busca resaltar la importancia en el servicio de urgencias de la asociación de la cefalea tipo trueno, con condiciones vasculares como la disección aórtica.
