Aortic Dissection

2020 ◽  
Author(s):  
Christine E Lee ◽  
Leily Naraghi ◽  
Beatrice Hoffmann
Keyword(s):  
Back Pain ◽  
Aortic Dissection ◽  
Key Words ◽  
Intramural Hematoma ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Emergency Physicians ◽  
Key Words Aortic Dissection ◽  
Aortic Dissections ◽  
Intimal Tear

Aortic dissections are associated with high morbidity and mortality and thus are important diagnoses to consider, as delaying diagnosis can have drastic consequences. Emergency physicians should consider dissection in patients with the classic presentation of tearing chest and/or back pain but should also be aware that its presentation can be varied based on the location of the dissection. This review summarizes the pathophysiology, presentation, stabilization and assessment, diagnosis, treatment, disposition, and outcomes for patients with aortic dissection.   This review contains 6 figures, 2 tables, 1 video, and 78 references. Key Words: aortic dissection, ascending aortic dissection, descending aortic dissection, intimal tear, intramural hematoma

Aortic Aneurysm

2018 ◽  
Author(s):  
Christine E Lee ◽  
Leily Naraghi ◽  
Beatrice Hoffmann
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Intramural Hematoma ◽  
Aortic Disease ◽  
Magnetic Resonance Images ◽  
Aortic Aneurysms ◽  
High Morbidity ◽  
Aortic Diseases ◽  
Decision Algorithm ◽  
Type B Dissection

Aortic diseases are relatively rare but are associated with high morbidity and mortality. Emergency physicians (EPs) should consider aortic disease in all patients with pain in the torso, particularly those with other diverse or seemingly unconnected complaints. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for patients with abdominal aortic aneurysms (AAAs), thoracic aortic aneurysms (TAAs), and aortic dissection. Figures show a transverse image of an AAAs with a transmural hematoma, a three-dimensional computed tomographic angiogram (CTA) rendering of a thoracic aneurysm associated with a bicuspid aortic valve in the typical ascending aortic location, a chest x-ray film demonstrating prominent and blurred aortic knob due to TAA, acute aortic dissection subtypes, an electrocardiogram and transesophageal echocardiography of a patient with acute ascending aortic dissection, magnetic resonance images of a patient with dissection of the proximal descending aorta, CT representations of a type A dissection involving a dilated ascending aorta and a type B dissection involving the descending thoracic aorta, and a decision algorithm for evaluation and treatment of a suspected aortic dissection. Tables list normal aortic dimensions by CTA and echocardiography, average annual rate of expansion and rupture of AAA based on current diameter, and the etiology of TAA. Key words: AAA, aorta, aortic dissection, ascending aortic dissection, descending aortic dissection, intimal tear, intramural hematoma, thoracic aortic aneurysm

scholarly journals Head and Neck Pain in Patients Presenting with Acute Aortic Dissection

Aorta ◽  
2018 ◽  
Vol 06 (06) ◽  
pp. 130-138 ◽  
Author(s):  
Stephen Philip ◽  
Emil Missov ◽  
Dan Gilon ◽  
Stuart Hutchison ◽  
Ali Khoynezhad ◽  
...  
Keyword(s):  
Back Pain ◽  
Aortic Dissection ◽  
Neck Pain ◽  
Head And Neck ◽  
Acute Aortic Dissection ◽  
Intramural Hematoma ◽  
Type A ◽  
White Female ◽  
Comorbidity Burden ◽  
Overall Mortality

Background Head and neck pain is an atypical presentation of acute aortic dissection. Classic teaching associates this pain with proximal dissections, but this has not been extensively studied. Methods Patients enrolled in the International Registry of Acute Aortic Dissection from January 1996 to March 2015 were included in this study. We analyzed the demographics, presentation, treatment, and outcomes of Type A aortic dissection patients presenting with head and neck pain (n = 812, 25.8%) and compared it with those without these symptoms (n = 2,341, 74.2%). Results Patients with head and neck pain were more likely to be white, female, with a family history of aortic disease. Patients with head and neck pain had higher percentages of back pain (43.3% vs. 37.5%, p = 0.005) and chest pain (87.6% vs. 79.3%, p < 0.001). On imaging, a higher percentage of those with head and neck pain had arch vessel involvement (44.3% vs. 38%, p = 0.010) and intramural hematoma (11.7% vs. 8.1%, p = 0.003). Surgical management was more common in patients with head and neck pain (89.8% vs. 85.2%, p = 0.001). Regarding outcomes, patients with head and neck pain had significantly higher rates of stroke than those without head and neck pain (13% vs. 9.9%, p = 0.016); however, overall mortality was lower for those with head and neck pain (19.5% vs. 23%, p = 0.038). Those with head and neck pain only had higher overall mortality compared to those with head and neck pain with chest or back pain (34.6% vs. 19.9%, p = 0.013). A logistic regression of mortality revealed that preoperative hypotension and age > 65 years were significantly associated with increased mortality. Conclusion Presence of head and neck pain in Type A dissection is associated with more arch involvement, intramural hematoma, and stroke. When isolating those with head and neck pain only, there appear to be a higher rate of comorbidity burden and higher overall mortality.

scholarly journals Detection of the intimal tear in aortic dissection and ulcer-like projection in intramural hematoma: usefulness of full-phase retrospective ECG-gated CT angiography

2020 ◽  
Vol 38 (11) ◽  
pp. 1036-1045
Author(s):  
Satoru Yanagaki ◽  
Takuya Ueda ◽  
Atsuro Masuda ◽  
Hideki Ota ◽  
Yuta Onaka ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Aortic Dissection ◽  
Ct Angiography ◽  
Intramural Hematoma ◽  
Ascending Aorta ◽  
Single Center ◽  
Descending Aorta ◽  
Diastolic Phase ◽  
Electrocardiogram Ecg ◽  
Intimal Tear

Abstract Purpose To compare the accuracy of non-electrocardiogram (ECG)-gated CT angiography (CTA), single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA in detecting the intimal tear (IT) in aortic dissection (AD) and ulcer-like projection (ULP) in intramural hematoma (IMH). Materials and methods A total of 81 consecutive patients with AD and IMH of the thoracic aorta were included in this single-center retrospective study. Non-ECG-gated CTA, single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA were used to detect the presence of the IT and ULP in thoracic aortic regions including the ascending aorta, aortic arch, and proximal and distal descending aorta. Results The accuracy of detecting the IT and ULP was significantly greater using full-phase ECG-gated CTA (88% [95% CI: 100%, 75%]) than non-ECG-gated CTA (72% [95% CI: 90%, 54%], P = 0.001) and single-diastolic-phase ECG-gated CTA (76% [95% CI: 93%, 60%], P = 0.008). Conclusion Full-phase ECG-gated CTA is more accurate in detecting the IT in AD and ULP in IMH, than non-ECG-gated CTA and single-diastolic-phase ECG-gated CTA.

Aortic Aneurysm

2018 ◽  
Author(s):  
Christine E Lee ◽  
Leily Naraghi ◽  
Beatrice Hoffmann
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Intramural Hematoma ◽  
Aortic Disease ◽  
Magnetic Resonance Images ◽  
Aortic Aneurysms ◽  
High Morbidity ◽  
Aortic Diseases ◽  
Decision Algorithm ◽  
Type B Dissection

Aortic diseases are relatively rare but are associated with high morbidity and mortality. Emergency physicians (EPs) should consider aortic disease in all patients with pain in the torso, particularly those with other diverse or seemingly unconnected complaints. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for patients with abdominal aortic aneurysms (AAAs), thoracic aortic aneurysms (TAAs), and aortic dissection. Figures show a transverse image of an AAAs with a transmural hematoma, a three-dimensional computed tomographic angiogram (CTA) rendering of a thoracic aneurysm associated with a bicuspid aortic valve in the typical ascending aortic location, a chest x-ray film demonstrating prominent and blurred aortic knob due to TAA, acute aortic dissection subtypes, an electrocardiogram and transesophageal echocardiography of a patient with acute ascending aortic dissection, magnetic resonance images of a patient with dissection of the proximal descending aorta, CT representations of a type A dissection involving a dilated ascending aorta and a type B dissection involving the descending thoracic aorta, and a decision algorithm for evaluation and treatment of a suspected aortic dissection. Tables list normal aortic dimensions by CTA and echocardiography, average annual rate of expansion and rupture of AAA based on current diameter, and the etiology of TAA. This review contains 3 figures, 3 tables, 4 videos and 66 references. Key words: AAA, aorta, aortic dissection, ascending aortic dissection, descending aortic dissection, intimal tear, intramural hematoma, thoracic aortic aneurysm

scholarly journals Surgical treatment of intramural hematoma of the ascending aorta

2016 ◽  
Vol 144 (3-4) ◽  
pp. 196-199
Author(s):  
Stamenko Susak ◽  
Aleksandar Redzek ◽  
Vladimir Torbica ◽  
Jovan Rajic ◽  
Mirko Todic
Keyword(s):  
Aortic Dissection ◽  
Open Surgery ◽  
Aortic Wall ◽  
Acute Aortic Dissection ◽  
Treatment Options ◽  
Intramural Hematoma ◽  
Ascending Aorta ◽  
Vasa Vasorum ◽  
Convex Side ◽  
Intimal Tear

Introduction. Intramural hematoma of the aorta presents potentially fatal condition developing as a result of a vasa vasorum rupture. It is a major risk factor for developing a frank aortic dissection. Case Outline. A 65-year-old woman was admitted to our clinic for the second time, after her symptoms of chest pain and vertigo (with no electrocardiographic signs of myocardial infarction) hadn?t disappeared after several months of medicament treatment (indicated in the first hospitalization). Computed tomography arteriography of the aorta showed no sign of acute aortic dissection, but revealed a contrast depo in the aortic wall of 8 ? 14 mm dimensions, with no extravasation of contrast. Also, massive pericardial effusion was observed (10-30 mm in thickness). Transesophageal echocardiography confirmed these findings completely. The patient underwent surgery, in which plaque exulceration was detected on the convex side of the ascending aorta, 3 cm above the aortic valve, 1 cm in diameter, with no signs of intimal tear. A resection of the ascending aorta was performed, and the aorta was reconstructed with a 30 mm Dacron tube graft. The patient was discharged on the 14th postoperative day with satisfactory results. Conclusion. Intramural hematoma is not a common event, but it is potentially a fatal one. Open surgery in patients with an intramural hematoma is an effective treatment strategy, although percutaneous endovascular treatment options are being described.

scholarly journals Streptococcus Intermedius Lung Abscess in a 17-year-old Male

2019 ◽  
Vol 6 ◽  
pp. 11-14
Author(s):  
Jason Andrew Levine ◽  
Karen Hovsepyan ◽  
Daniel Lubarsky ◽  
Deepa Mukundan ◽  
Jennifer Ruddy
Keyword(s):  
Back Pain ◽  
Rare Disease ◽  
Pediatric Population ◽  
Disease Process ◽  
Lung Abscess ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Streptococcus Intermedius ◽  
Infectious Process ◽  
Rare Diagnosis

Streptococcus intermedius lung abscess and empyema is a chronic infectious process associated with a high morbidity and mortality.  It is typically seen in adults, and is considered a rare disease process in the pediatric population.  Our case describes a 17 year old male presenting with 3 months of cough associated with later development of chest and back pain.  He was later found to have a severe empyema secondary to Streptococcus intermedius.  This case underlines a rare diagnosis in the pediatric population, as well as a association with smoking and vaping. 

scholarly journals A Massive Aortic Intramural Haematoma – an Aortic Emergency

2016 ◽  
Vol 2 (1) ◽  
pp. 32-36
Author(s):  
Beáta Jakó ◽  
Laura Jani ◽  
Diana Opincariu ◽  
András Mester ◽  
István Kovács ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Wall ◽  
Acute Aortic Dissection ◽  
Clinical Care ◽  
Intramural Hematoma ◽  
Mortality Rates ◽  
Intramural Haematoma ◽  
Aortic Media ◽  
Fatal Complications ◽  
Intimal Tear

Abstract Aortic intramural haematoma (AIH) is a rarely recognized disease characterized by a sudden haemorrhage into aortic media in the absence of any intimal tear. The clinical evolution and mortality rates of AIH are similar to those of acute aortic dissection. However, in the acute clinical care of patients presenting with chest pain of aortic origin, it is important to differentiate intramural haematoma from aortic dissection. A case of an elderly patient with an intramural hematoma (IMH), which progressed to very large dimensions and involved the entire aortic wall, resulting in fatal complications is presented here.

Management of oesophageal anastomosis dehiscence after oesophagectomy for oesophageal cancer

2020 ◽  
Vol 99 (5) ◽  
pp. 200-206
Keyword(s):  
Oesophageal Cancer ◽  
Surgical Procedure ◽  
Anastomotic Dehiscence ◽  
Gastric Conduit ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Therapeutic Algorithm

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.

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