Non-contrast computed tomography of type A acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest: a case series

Abstract Background The prognosis of patients admitted for acute aortic dissection (AAD) has remarkably improved. However, we must also consider out-of-hospital cardiopulmonary arrest (OHCPA) patients while assessing the prognosis. In recent years, autopsy imaging has become more common as an alternative to conventional autopsy. Therefore, we reviewed our OHCPA patients with type A AAD using acute phase non-contrast computed tomography (CT). Case summary Here, we report a case series of three patients who developed OHCPA and were diagnosed with type A AAD using non-contrast CT. Although the direct causes of death varied in each case, we could easily determine the direct causes of death from clinical course of the condition and from non-contrast CT. Discussion Although non-contrast CT does not completely replace autopsy, if its convenience and non-invasiveness make it possible for more patients to undergo the procedure, the real prognosis (including morbidity and mortality) may be better understood. Therefore, we considered it significant to use non-contrast CT for investigating the cause of sudden death.

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Incidence and characteristics of acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest evaluated by non-contrast computed tomography

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620923647 ◽

2020 ◽

Vol 9 (3_suppl) ◽

pp. S48-S57 ◽

Cited By ~ 1

Author(s):

Shinsuke Takeuchi ◽

Yoshihiro Yamaguchi ◽

Kyoko Soejima ◽

Hideaki Yoshino

Keyword(s):

Computed Tomography ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Aortic Rupture ◽

Cardiopulmonary Arrest ◽

Type A ◽

Thoracic Cavity ◽

Type B ◽

Related Factors ◽

Tomography Data

Background The exact epidemiology of acute aortic dissection, including cases of out-of-hospital cardiopulmonary arrest, is unclear. We aimed to investigate the incidence and characteristics of acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest transferred to our institution and validate the related factors to out-of-hospital cardiopulmonary arrest in Stanford type A acute aortic dissection. Methods We retrospectively reviewed the acute-phase computed tomography data of patients with out-of-hospital cardiopulmonary arrest who visited our hospital between 1 January 2015 and 31 December 2017. Results Among 1011 consecutive patients with out-of-hospital cardiopulmonary arrest, excluding those aged 17 years and younger and exogenous out-of-hospital cardiopulmonary arrest, such as suicide and trauma, 934 underwent computed tomography examination and 71 (7.6%) were diagnosed with acute aortic dissection: 66 with Stanford type A and five with type B acute aortic dissection (out-of-hospital cardiopulmonary arrest group). Seventy-five patients without out-of-hospital cardiopulmonary arrest with Stanford type A acute aortic dissection visited our institution during the same period (non-out-of-hospital cardiopulmonary arrest group). Age, incidence of massive bloody pericardial effusion and massive intrathoracic haemorrhage were significantly higher in the out-of-hospital cardiopulmonary arrest than in the non-out-of-hospital cardiopulmonary arrest group (78 ± 8 years, 72.7% and 24.2% vs. 70 ± 13 years, 26.7% and 1.3%, respectively; all P < 0.01). These variables were independently related to out-of-hospital cardiopulmonary arrest. Conclusions There may be more patients with acute aortic dissection with out-of-hospital cardiopulmonary arrest than previously thought. Aortic rupture into the pericardial space or thoracic cavity is the major cause of out-of-hospital cardiopulmonary arrest in these cases. Non-contrast computed tomography can be used to diagnose acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest. Our study is one of a few to evaluate the real circumstances surrounding acute aortic dissection and its epidemiology.

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Prognostic Impact of Branch Vessel Involvement on Computed Tomography versus Clinical Presentation of Malperfusion in Patients With Type a Acute Aortic Dissection

The American Journal of Cardiology ◽

10.1016/j.amjcard.2021.05.005 ◽

2021 ◽

Author(s):

Osamu Hashimoto ◽

Yuichi Saito ◽

Takashi Nakayama ◽

Shinichi Okino ◽

Yoshiaki Sakai ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Clinical Presentation ◽

Type A ◽

Prognostic Impact ◽

Branch Vessel ◽

Vessel Involvement

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Iatrogenic Catheter-Induced Acute Aortic Dissection Type A after Coronary Angiography—A Retrospective Consecutive Case Series

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1594290 ◽

2016 ◽

Vol 65 (02) ◽

pp. 085-089

Author(s):

Jan Dreyer ◽

Bernd Panholzer ◽

Christina Grothusen ◽

Jochen Renner ◽

Philipp Schäfer ◽

...

Keyword(s):

Coronary Angiography ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Case Series ◽

Type A ◽

Consecutive Case ◽

Aortic Dissection Type A

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Optimal phase analysis of electrocardiogram-gated computed tomography angiography in patients with Stanford type A acute aortic dissection

European Journal of Radiology Open ◽

10.1016/j.ejro.2020.100289 ◽

2020 ◽

Vol 7 ◽

pp. 100289

Author(s):

Kenji Nishida ◽

Yuki Yokoi ◽

Ayumi Yamada ◽

Nobuhiro Takaya ◽

Ken Yamagiwa ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Dissection ◽

Phase Analysis ◽

Computed Tomography Angiography ◽

Acute Aortic Dissection ◽

Type A

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Frank's sign with acute aortic dissection

10.22541/au.163846246.64225415/v1 ◽

2021 ◽

Author(s):

Hironobu Nishiori ◽

Yuichi Hirano ◽

Masayoshi Otsu ◽

Hiroyuki Watanabe

Keyword(s):

Computed Tomography ◽

Back Pain ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Young Patients ◽

Type A ◽

Aortic Disease ◽

Atherosclerotic Disease ◽

Smoking History

A 59-year-old man with a long smoking history presented with sudden back pain. Frank’s sign was noticed in his bilateral ears, and computed tomography revealed Stanford type A acute aortic dissection. If young patients have Frank’s sign, attention should be paid to atherosclerotic disease including aortic disease.

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Anterograde Amnesia as a Manifestation of Acute Type A Aortic Dissection

International Journal of Angiology ◽

10.1055/s-0039-1693029 ◽

2019 ◽

Vol 29 (04) ◽

pp. 263-266 ◽

Cited By ~ 1

Author(s):

Claudia Stöllberger ◽

Julia Koller ◽

Josef Finsterer ◽

Dominic Schauer ◽

Marek Ehrlich

Keyword(s):

Computed Tomography ◽

Chest Pain ◽

Aortic Dissection ◽

Memory Impairment ◽

Acute Aortic Dissection ◽

Anterograde Amnesia ◽

Type A ◽

Type A Aortic Dissection ◽

D Dimer ◽

Aortic Dissection Type A

Objectives Memory impairment has been only rarely reported in association with acute aortic dissection type A. We report a patient with pure anterograde amnesia and memory impairment of contents occurring after the event, accompanying acute aortic dissection type A. Case Report A previously healthy 53-year-old Caucasian male was admitted because of sudden chest pain after having lifted a heavy object. Clinical examination and electrocardiogram showed no abnormalities. Since blood tests showed leukocytosis, anemia, and elevated D-dimer level, either pulmonary embolism or aortic dissection was suspected; therefore, computed tomography was suggested. The patient seemed disoriented to time, and neurologic investigation confirmed that the patient was disoriented to time; short time memory was severely impaired and concentration was reduced. An amnestic episode with anterograde amnesia was diagnosed. Computed tomography showed type A aortic dissection. A supracoronary replacement of the ascending aorta was performed. The patient was discharged on the 7th postoperative day. Three months postoperatively, the patient is clinically stable; however, amnesia for the interval between pain onset and cardiac surgery persists. Conclusions Transient amnesia, usually considered a benign syndrome, may be more common than generally recognized in aortic dissection. The suspicion for aortic dissection or other cardiovascular emergencies is substantiated when amnesia is associated with sudden onset of chest pain, leukocytosis, and elevated D-dimer levels. Computed tomography of the aorta with contrast medium is the imaging method of choice to confirm or exclude the diagnosis.

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INCIDENCE AND CAUSE OF DEATH OF ACUTE AORTIC DISSECTION IN PATIENTS WITH OUT-OF-HOSPITAL CARDIOPULMONARY ARREST ANALYZED BY COMPUTED TOMOGRAPHY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)32664-6 ◽

2019 ◽

Vol 73 (9) ◽

pp. 2058

Author(s):

Shinsuke Takeuchi ◽

Hideaki Yoshino

Keyword(s):

Computed Tomography ◽

Aortic Dissection ◽

Cause Of Death ◽

Acute Aortic Dissection ◽

Cardiopulmonary Arrest

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P1825The characteristics of type A acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest analyzed by computed tomography

European Heart Journal ◽

10.1093/eurheartj/ehz748.0577 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Takeuchi ◽

H Yoshino ◽

Y Yamaguchi ◽

K Soejima

Keyword(s):

Pericardial Effusion ◽

Aortic Dissection ◽

Acute Phase ◽

Acute Aortic Dissection ◽

Cardiopulmonary Arrest ◽

Multivariate Logistic Regression Analysis ◽

Type A ◽

High Morbidity ◽

Survival Group ◽

Ct Findings

Abstract Background/Introduction Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality rates, and is reported to have a 1–2% fatality rate per hour after onset. Therefore, many cases with AAD are considered to be included in patients with out-of-hospital cardiopulmonary arrest (OHCPA). However at this time, there is a lack of documentation of these cases. Purpose In this study, we investigated the characteristics of Stanford type A AAD (TAAD) cases between OHCPA cases and survival cases using acute phase CT. Methods An acute phase CT scanning was performed on consecutive patients with OHCPA transported to our hospital in order to estimate the causes of cardiopulmonary arrest (CPA). Based on our emergency outpatient databases, we retrospectively reviewed the acute phase CT findings of OHCPA TAAD cases and survival TAAD cases diagnosed at our hospital during the same period. Results Of 1,011 consecutive patients with OHCPA, except for exogenous death from 1 January 2015 to 31 December 2017, 934 patients underwent CT examination in the acute phase. Based on the clinical course and CT findings, 71 of the 934 patients (7.6%) were diagnosed with AAD. Out of 71 AAD patients, 66 were TAAD patients, and all of these patients were enrolled in the OHCPA group. On the other hand, 41 patients were registered as the survival group during the same period. These patients were diagnosed as TAAD and were admitted to our hospital without falling into CPA. Increased Age (78±8 years old vs 69±13 years old, P<0.01), visible intimal flap (63.6% vs 41.5%, P=0.043), bloody pericardial effusion (72.7% vs 26.8%, P<0.01), hemothorax (24.2% vs 0%, P<0.01) were significant in patients with the OHCPA group compared with the survival group. In addition, 56 patients with OHCPA (84.8%) had at least one of massive bloody pericardial effusion or massive hemothorax. Using multivariate logistic regression analysis, increased age and bloody pericardial effusion were both found to be independent factors related to OHCPA. Conclusion In this study, it is thought that the main characteristics of the CT findings with OHCPA due to TAAD are a rupture of the aorta into the pericardial cavity or thoracic cavity.

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