Classical symptoms of AD include an acute onset of severe chest, back, and . The clinical challenges of this case lie in: (i) atypical presentation of aortic dissection and (ii) worsening acute liver failure which could led to unnecessary liver transplantation. An unusual presentation of thoracic aortic dissection in a 73 year old man is described. Syncope is part of the early course of aortic dissection in approximately 5% of patients and may be the result of increased. INTRODUCTION Aortic dissection is a serious condition in which there is a tear in the wall of aorta. Case #1: 35 year-old male A 35-year-old male presented to the ED with complaints of chest pain and diaphoresis. However, masquerade presentations of TBAD as ALI are rare in the literature. Surgical . In this case, presentation with new onset back and right leg pain occurred on the first day of symptoms and urgent investigations were instituted. Aortic dissection is relatively uncommon. Many patients die before arriving at the hospital or prior to diagnosis [1]. Discussion. This report illustrates the clinical implications of CTAAD that occurred in two patients shortly after the peak phase of the COVID-19 pandemic in our country. The dissection is likely completely incidental to the injury, as aortic dissection is not typically associated with trauma. Aortic dissection is the most common acute aortic syndrome, and it is an important differential of chest pain. Chances of survival decreases by 10% per hour if left untreated. Also rare is spontaneous coronary artery dissection (SCAD), a form of acute coronary syndrome, which develops in relatively young women without coronary risk factors. Aortic dissection carries high morbidity and mortality. Rogers AM, Hermann LK, Booher AM, et al. Case presentation Our patient was a 55-year-old white man who presented to our emergency department (ED) with a 2-day history of severe, dull, constant left flank pain with radiation to his groin, and nausea with no vomiting. Download Free PDF. Dissection most commonly occurs with a discrete intimal tear, but can occur without one. AD involving the carotid arteries could be associated with many clinical presentations, ranging from stroke to nonspecific headache. Type 1 originates in the ascending aorta and to at least the aortic arch. He was admitted to hospital with severe left sided pleuritic chest pain. Aortic Dissection: Etiology 8 Aortic dissections often occur in patients with preexisting degeneration of the aortic media. Continue Reading. Aortic dissection may present with chest pain, aortic regurgitation, myocardial ischaemia, congestive heart failure, pleural effusions, syncope, neurological symptoms (eg, acute paraplegia, upper or lower limb ischaemic neuropathy), mesenteric ischaemia and acute kidney injury [ 1]. Aortic dissection is a very rare but life-threatening complication of TOE with a lethality rate of 1-2% per . Aortic dissection occurs when blood enters the medial layer of the . A 1998 study that reviewed a series of aortic dissection cases showed that for the 42% of physicians who asked these 3 questions, the diagnosis was suspected in 91%. Case presentation. Cardiac tamponade due to aortic injury after blunt trauma is a rare and potentially fatal injury. Pain Pearl #2: Think of aortic dissection as the subarachnoid hemorrhage of the torso 52 yr old male from Theog Date & time of presentation in casualty- 7th May 2014/9:20 pm Chief complaints: Back pain since 7th May 2014/7:30 pm 3. The estimated incidence ranges from 2.6 to 3.5 cases per 100,000 person-years [2]. On rare occasions, type A aortic dissection is present in an asymptomatic or mildly symptomatic patient, deviating from the more common, rapidly progressive presentation. Introduction Aortic dissection is a surgical emergency with an incidence of three per 100,000 and a mortality rate of 25% to 30% [1-4]. No pericardial effusion. The symptoms of aortic dissection can be similar myocardial ischemia, and physical findings in the physical examination of aortic dissection may be absent. To assess the presentation, management, and outcomes of acute aortic dissection. 2022, Annals of Thoracic and Cardiovascular Surgery. Accidental and Late Diagnosis of Type A Aortic Dissection: Mimicking Unstable Angina Pectoris October 2022 Journal of Investigative Medicine High Impact Case Reports 10:23247096221127118 Neurologic deficits are a presenting sign in as many as 20% of cases. TBAD with typical or atypical clinical features presented with ALI as a malperfusion syndrome is not uncommon. In most cases, the intimal flap must be retained in order to restore aortic valve competence and reconstruct the coronary ostia. In this case, the deceased was aware of developing symptoms of heart . Slow leakage or exudate stemming from the dissecting hematoma appeared to have caused pericardial inflammation. Diuretic medications improved the patient's status of heart failure due to pericarditis; however, inflammation extending to the adventitia was a possible cause of aortic dissection. The heart showed a white villous surface, and the pericardium was fibrously thick. Download . He had a history of Coronary artery . Some cases with aortic dissection (AD) could present with various complaints other than pain, especially neurological and cardiovascular manifestations. Painless aortic dissection is relatively rare, and can be easily missed due to its atypical presentation. Aortic dissection consists of a tear in the intimal layer of the aortic wall, thus connecting the media with the aortic lumen and allowing the blood to flow from the true lumen, delimited by the intimal layer, into the false lumen, localized between the intima and media of the aortic wall [ 2 ]. Chest x ray showed cardiomegaly with right lung shadowing, and ventilation/perfusion scan was negative. First Case Presentation However, aortic dissection can be asymptomatic in the acute phase with delayed symptomatic presentation or incidental diagnosis upon chest imaging. However, all of these injuries were observed in the descending aorta because they had been caused by a posterior rib fracture. Presentation of case. Here, we discuss the case of a 35-year-old woman who was 37 weeks pregnant and presented with dizziness and blurred vision. 1 a sudden onset of severe chest, back or abdominal pain represents the most frequent symptom; however, atypical presentation is seen in Both fulminant liver failure . Circulation 2011; 123:2213. However, imaging takes time to provide a diagnosis, possibly causing delays in surgical treatment. Download Free PDF . Records with a diagnosis of 'dissection of aorta" (International Classification of Diseases, Tenth Revision code I71.0) from the hospital discharge database and hospital death register were. Aortic dissection describes the condition when a separation has occurred in aortic wall intima, causing blood flow into a new false channel composed of the inner and outer layers of the media. Download. CLASSIFICATION Cardiovascular professionals should be aware about the risk factors, means of prevention and best management options for IAAD in the perioperative setting. If the blood goes through the outside aortic wall, aortic dissection is often deadly. 1, 2 type-a aad with acute coronary involvement is successfully treated with ascending aorta replacement in open-chest surgery. However, this cannot be verified as we did not use continuous BP measurement during the TOE procedure. Acute aortic dissection is a rare condition, such that many patients will not survive without reconstructive surgery. The clinician needs to remain vigilant for such atypical presentations. An aortic dissection is one of the acute aortic syndromes and a type of arterial dissection. TRANSCRIPT 1. Regardless of the chronicity of the dissection, catastrophic complications can still occur at any point, leading to high morbidity and mortality rates. Sudden onset tearing chest pain is the classic presentation, but aortic dissection can have a variable presentation due to the aorta's anatomic course. The dissection extends to the origin of the coronary arteries, with the right coronary artery supplied by the false lumen and the left main coronary artery supplied by the true lumen. Aortic dissection often presents in two phases: Aortic dissection Acute aortic dissection is defined as dissection occurring within 2 weeks of onset of pain [ 2 ]. In this paper, we report a case of anterior spinal cord ischemia caused by aortic artery dissection (AAD) with literature review for other similar cases, aiming to come out with certain criteria for patient at risk, common clinical presentations, imaging findings, different therapeutic modalities, and outcome, hoping to help in improving the diagnostic and therapeutic yield of such rare yet . It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second blood-filled channel within the wall. No hemopericardium. PRESENTATION Symptoms acute onset of severe chest or back pain : 80 to 90% , severe, sharp, or "tearing" and is located in the anterior chest pain for type A aortic dissection and in the posterior chest or back pain for type B aortic dissection Signs Asymmetric limb pulses shock, syncope, acute congestive heart failure, myocardial ischemia, stroke, paraplegia, extremity ischemia, mesenteric . Microscopic examination revealed pericarditis with predominantly macrophage and lymphocyte infiltration. An aortic dissection is considered acute if the process is less . Type 2 originates in and is limited to the ascending aorta. Causes and risk factors include connective tissue disorders, atherosclerotic disease, and injury Conditions Contributing to Aortic Dissection CATEGORY EXAMPLES ATHEROSCLEROTIC RISK FACTORS COCAINE DYSLIPIDEMIA HTN SMOKING There are two standard anatomical classifications . The strengths of our case report include the unique presentation of a new diagnosis of aortic aneurysm in a young pregnant woman with no known risk factors and multiple imaging studies that showed no evidence of dissection. He was examined by our insured physician, who initiated a full chest pain work-up. Although patients generally present with acute symptoms and classic signs, a subset of patients may present with syncope, GI bleeding, and neurological deficits. He was found to have type A aortic dissection on imaging in the setting of severe patient-prosthesis mismatch. acute aortic dissection represents an uncommon diagnosis with a wide spectrum of clinical presentation that carries a high risk of morbidity and mortality due to acute life-threatening complications. Thoracic aortic dissection should be considered for every patient presenting to the emergency department with chest pain or back pain, particularly if accompanied by neurologic signs or symptoms. We presumed that death in the present case was caused by pericarditis-induced fragility of the aortic wall followed by cardiac tamponade. Aortic dissection can can kill if not recognised and managed early. Because cerebral infarction with aortic dissection is a contraindication to intravenous recombinant tissue plasminogen activator (rt-PA) therapy, exclusion of aortic dissection is necessary prior to its administration. Nevertheless, we experienced two cases of chronic type A aortic dissection (CTAAD) in July 2020, which is a pathology we usually see only once every 5 years . Clinical discussion: We report a case of acute TBAD presented as isolated ALI, which was initially diagnosed and treated as an ALI unrelated to aortic dissection. 2. A 59-year-old man presented with chronic type B aortic dissection with aneurysmal dilatation. Case presentation A 53-year-old woman was brought to our . Aortic dissection is the surging of blood through a tear in the aortic intima with separation of the intima and media and creation of a false lumen (channel). Several cases of delayed aortic injury have been reported. Kan NAWATA. If the aortic dissection involves the aortic root it may result in involvement of the coronary arteries and can present similarly to ST-elevation myocardial infarction on an ECG. A 59-year-old Caucasian patient at the time of presentation had been followed for several years by cardiac surgery for a history of a chronic type B aortic dissection, of hypertensive etiology, involving the ostium of the LSA and extending to the iliac bifurcation with multiple fenestrations. The characteristic presentation of an aortic dissection is of a tearing chest pain, classically radiating through to the back, yet the diagnosis is often challenging and many be a more subtle presentation. We report the case of a multiparous 35-year-old patient with gestational hypertension treated for a type A aortic dissection on the second postpartum day. Most aortic injuries caused by blunt trauma present as aortic dissection or rupture of the aortic isthmus. CASE PRESENTATION & REVIEW OF LITERATURE 2. Case presentation . 1,2 Per EMS, the patient was found on the street with decreased level of consciousness and poor respiratory effort. This case shows aortic dissection in a patient who had a stabbing wound. The aortic dissection should be considered. Background Aortic dissection is one of the causes of stroke. Blood rushes through the tear, causing the inner and middle layers of the aorta to split (dissect). Case Report. Although fibrinolytic therapy was contraindicated, considering risks and benefits, it may have been lifesaving in this case. Diameter of the ascending aorta is normal. Case presentation A 54-year-old man was admitted to the hospital with acute onset of right limb weakness . A Case of Acute Type A Aortic Dissection after Coronary Artery Bypass Grafting. December 2, 2020 by UCSD Ultrasound Case 25: Aortic Dissection A 44 year old male with a history of heroin abuse presents to the emergency department with altered mental status. Aortic dissection is characterised by a tear in the intimal and medial layers of the endovascular aortic wall which propagates distally. Aortic dissection (AD) is a relatively rare but dreadful illness, often accompanied by severe, sharp (or 'tearing') back pain or anterior chest pain, as well as acute hemodynamic compromise. Aortic complications in pregnancy have been described in genetic syndromes or congenital aortic . He had a past medical history of end stage renal disease, congestive heart failure, atrial fibrillation, a type B aortic dissection, peripheral arterial disease, bladder cancer, chronic obstructive pulmonary disease, hepatitis C, hypertension, obstructive sleep . It highlighted the importance of prompt identification of acute aortic dissection as the aetiology of fulminant acute liver failure. Background Iatrogenic acute aortic dissection (AAD) caused by cardiovascular intervention is rare. CASE 1 University Teaching Hospital 53/fadmitted to Heart Emergency Centre Chest pain/discomfort 1 hour right leg numbness PMH- Hypertension not on medication The patient underwent ECG, chest radiology, and ultrasound, where . The patient had undergone prosthetic graft replacement of the ascending aorta for acute type A aortic dissection 3 years previously and replacement of the descending aorta for residual type B aortic dissection with aneurysmal . In this study, we examine two cases of undiagnosed aortic dissection that resulted in negative consequences, and we offer tips to avoid similar outcomes.