scholarly journals Atypical Presentation of Aortic Dissection: A Case Report

2021 ◽  
Vol 10 (3) ◽  
pp. 129-131
Author(s):  
Soraya Shamizadeh ◽  
Golamreza Faridaalaee
Keyword(s):  
Case Report ◽  
Aortic Dissection ◽  
Epigastric Pain ◽  
Obese Woman ◽  
Intravenous Contrast ◽  
Atypical Symptoms ◽  
Coronary Syndrome ◽  
Mortality Case ◽  
Life Threatening ◽  
Rule Out

Background: Aortic dissection (AD) is considered to be one of the life-threatening diseases. Quick diagnosis has great significance so that a one-hour delay in treatment leads to a 1-2% increase in mortality. Case Report: The 55-year old obese woman with epigastric pain and right upper quadrant pain referred to the emergency department of our hospital. The acute coronary syndrome was our initial diagnosis but an image similar to a Perl in one cut and a crescent in another cut of computed tomography (CT) drew our attention in the mediastinal view of CT without intravenous contrast that was performed to rule out coronavirus disease-19 (COVID-19). Finally, CT-angiography was requested and AD diagnosis was approved accordingly. Conclusion: The presence of calcification on a non-contrast chest CT in the middle of the aorta or away from the artery wall can be a sign of AD. Thus, special attention should be paid to the atypical symptoms of AD.

scholarly journals Aortic Dissection Presenting as Acute Pancreatitis: Suspecting the Unexpected

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Adam Hafeez ◽  
Dillon Karmo ◽  
Adrian Mercado-Alamo ◽  
Alexandra Halalau
Keyword(s):  
Blood Pressure ◽  
Acute Pancreatitis ◽  
Aortic Dissection ◽  
Epigastric Pain ◽  
Pressure Control ◽  
Sudden Onset ◽  
Medical Emergency ◽  
Threatening Condition ◽  
Life Threatening ◽  
Normal Triglyceride

Aortic dissection is a life-threatening condition in which the inner layer of the aorta tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). It is considered a medical emergency. We report a case of a healthy 56-year-old male who presented to the emergency room with sudden onset of epigastric pain radiating to his back. His blood pressure was 167/91 mmHg, equal in both arms. His lipase was elevated at 1258 U/L, and he was clinically diagnosed with acute pancreatitis (AP). He denied any alcohol consumption, had no evidence for gallstones, and had normal triglyceride level. Two days later, he endorsed new suprapubic tenderness radiating to his scrotum, along with worsening epigastric pain. A MRCP demonstrated evidence of an aortic dissection (AD). CT angiography demonstrated a Stanford type B AD extending into the proximal common iliac arteries. His aortic dissection was managed medically with rapid blood pressure control. The patient had excellent recovery and was discharged home without any surgical intervention.

Sudden death due to aortic dissection in early pregnancy – a case report

2017 ◽  
Vol 85 (3) ◽  
pp. 162-164 ◽  
Author(s):  
Akshith RS Shetty ◽  
YP Girish Chandra ◽  
S Praveen ◽  
Somusekhar Gajula
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Sudden Death ◽  
Aortic Dissection ◽  
Early Pregnancy ◽  
First Trimester ◽  
Ascending Aorta ◽  
Severe Chest Pain ◽  
Rule Out

Forensic pathologists come across many deaths due to natural causes which are sudden. Sudden natural deaths in females who are pregnant warrant thorough investigation and a medico-legal autopsy to rule out any foul play. Here, we report a case of 21-year-old primigravida in her first trimester who suddenly complained of severe chest pain and was brought dead to the hospital with no history suggestive of prior natural disease. At autopsy, the death was attributed to dissection of ascending aorta.

scholarly journals Aortic Dissection with Rare Anatomical Aortic Arch Variation Depicted by Computed Tomography Angiography

2021 ◽  
Vol 24 (2) ◽  
pp. E407-E408
Author(s):  
Xin Wang ◽  
Bofu Liu ◽  
Haifang Yu
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Aortic Dissection ◽  
Effective Treatment ◽  
Aortic Arch ◽  
Endovascular Repair ◽  
Computed Tomography Angiography ◽  
Chest Trauma ◽  
Life Threatening ◽  
Treatment Surgery

Aortic dissection (AD) is a life-threatening disease, and endovascular repair by stent graft is an effective treatment. Surgery often fails for a variety of reasons, such as aortic arch variation. We present the case of a 27-year-old female with aortic dissection with a rare anatomical aortic arch variation caused by chest trauma. This patient recovered well after endovascular repair. This case report demonstrates endovascular repair can be applied to aortic dissection patients with rare anatomical aortic arch variation.

scholarly journals Outcomes of Preoperative Antiplatelet Therapy in Patients with Acute Type A Aortic Dissection

2021 ◽  
Author(s):  
Xuan Jiang ◽  
Enyi Shi ◽  
Ruixin Fan ◽  
Ximing Qian ◽  
Hongjia Zhang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Antiplatelet Therapy ◽  
Type A ◽  
Coronary Intervention ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Coronary Syndrome ◽  
Before And After ◽  
Life Threatening ◽  
Immediate Surgery

Background: Acute type A aortic dissection(ATAAD) is life-threatening and requires immediate surgery. Sudden chest pain may lead to a risk of misdiagnosis as acute coronary syndrome and may lead to subsequent antiplatelet therapy. We used the Chinese Acute Aortic Syndrome Collaboration Database (AAS) to study the effects of antiplatelet therapy (APT) on clinical outcomes. Methods: The AAS database is a retrospective multicentre database where 31 of 3092 had APT with aspirin or clopidogrel or both before surgery. Before and after propensity score matching, the incidence of complications and mortality was compared between APT and non-APT patients by using a logistic regression model. The sample remaining after PSM was 30 in the APT group and 80 in the non-APT group. Results: The sample remaining after matching was 30 in the APT group and 80 in the non-APT group. We found 10 cases with percutaneous coronary intervention in the APT group(33.3%). The APT group received more volume of packed red blood cell (RBC), 8.4±6.05 units; plasma, 401.67±727 ml, and platelet transfusion(14.07±8.92 units). The drainage volume was much more in the APT group( 5009.37±2131.44ml, P=0.004). Mortality was higher in APT group(26% vs 10%, P=0.027). The preoperative APT was independent predictor of mortality(OR 6.808, 95% CI1.554-29.828, P = 0.011). Conclusion: APT prior to ATAAD repair was associated with more transfusions and higher early mortality. The timing of surgery should be carefully considered based on the patient’s status and the surgeon’s experience.

Neonatal Enterovirus: A Case Report in a Term Infant Requiring Air Evacuation

2020 ◽  
Vol 39 (4) ◽  
pp. 215-221
Author(s):  
Morgan S. Shaff ◽  
C. Scott Love ◽  
Elizabeth V. Schulz
Keyword(s):  
Case Report ◽  
Clinical Symptoms ◽  
Response Times ◽  
Rapid Diagnosis ◽  
Term Infant ◽  
Clinical Complications ◽  
Life Threatening ◽  
Initial Hospital ◽  
Polymerase Chain ◽  
Rule Out

Enterovirus infections in neonates have the potential to cause a cascade of devastating clinical complications that can lead to death. Because of vague maternal symptom presentations, the diagnosis may not be obvious to antepartum adult providers. Clinicians evaluating infants in the newborn nursery and following initial hospital discharge must be alert for this potential infection. Common newborn issues, such as hyperbilirubinemia and weight loss, may be early signs of a more life-threatening diagnosis. Enterovirus infections may be responsible for a continuum of critical diagnoses in the neonate. Utilization of viral panels during the initial rule-out sepsis evaluation may provide rapid diagnosis and, ultimately, earlier response times to devastating clinical symptoms. Antepartum history and presenting features of enteroviral infections warrant rapid diagnosis with viral polymerase chain reaction detection panels to potentially reduce antibiotic usage and inpatient length of stay. The purpose of this case report is to review risk factors, presentation, and management of neonatal enterovirus infections. As this infant was born in a remote setting and required air evacuation, the logistics of this transport are also discussed.

Considerations for early acute myocardial infarction rule-out for emergency department chest pain patients: the case of copeptin

2012 ◽  
Vol 50 (2) ◽  
Author(s):  
Giuseppe Lippi ◽  
Mario Plebani ◽  
Salvatore Di Somma ◽  
Valter Monzani ◽  
Marco Tubaro ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Clinical Decision Making ◽  
Current Evidence ◽  
Emergency Physicians ◽  
Prognostic Information ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Rule Out

AbstractThe evaluation of patients admitted at the emergency department (ED) for chest pain is challenging and involves many different clinical specialists including emergency physicians, laboratory professionals and cardiologists. The preferable approach to deal with this issue is to develop joint protocols that will assist the clinical decision-making to quickly and accurately rule-out patients with non life-threatening conditions that can be considered for early and safe discharge or further outpatient follow-up, rule-in patients with acute coronary syndrome and raise the degree of alert of the emergency physicians on non-cardiac life-threatening emergencies. The introduction of novel biomarkers alongside the well-established troponins might support this process and also provide prognostic information about acute short-term or chronic long-term risk and severity. Among the various biomarkers, copeptin measurement holds appealing perspectives. The utility of combining troponin with copeptin might be cost-effective due to the high negative predictive value of the latter biomarker in the rule-out of an acute coronary syndrome. Moreover, in the presence of a remarkably increased concentration (e.g., more than 10 times the upper limit of the reference range), to reveal the presence of acute life-threatening conditions that may not necessarily be identified with the use of troponin alone. The aim of this article is to review current evidence about the clinical significance of copeptin testing in the ED as well as its appropriate placing within diagnostic protocols.

scholarly journals Clinical update. Computed Tomography — an Emerging Tool for Triple Rule-Out in the Emergency Department. A Review

2017 ◽  
Vol 3 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Mihaela Dobra ◽  
Lehel Bordi ◽  
Tiberiu Nyulas ◽  
Alexandra Stănescu ◽  
Mirabela Morariu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Chest Pain ◽  
Computed Tomographic ◽  
Coronary Syndrome ◽  
Negative Results ◽  
Number Of Patients ◽  
Triple Rule Out ◽  
Life Threatening ◽  
Unclear Etiology ◽  
Rule Out

AbstractNew imaging tools have been developed in recent years to rapidly and accurately diagnose life-threatening diseases associated with high mortality rates, such as acute coronary syndromes, acute aortic dissection, or pulmonary embolism. The concept of using computed tomographic (CT) assessment in emergency settings is based on the possibility of excluding multiple acute pathologies within one scan. It can be used for patients complaining of acute chest pain of unclear etiology with the possible association of acute coronary dissection or pulmonary embolism, but only a low to moderate risk of developing an acute coronary syndrome. One of the benefits of this protocol is the possibility of decreasing the number of patients who are hospitalized for further investigations. The technique also allows the rapid triage of patients and the safe discharge of those who show negative results. The aim of this review is to summarize the current medical literature regarding the potential use of CT for the triple rule-out (TRO) of coronary etiologies.

scholarly journals Spontaneous Coronary Artery Dissection in a Patient with a Family History of Fatal Ascending Aortic Dissection: Case Report and Discussion of Diseases Causing Both Presentations

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
George Joy ◽  
Hany Eissa
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Family History ◽  
Aortic Dissection ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Arterial Tree ◽  
Coronary Syndrome ◽  
History Of

Background. Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Aortic dissection and SCAD share common aetiologies such as a fibromuscular dysplasia (FMD), Marfan, Ehlers Danlos, and more rarely systemic lupus erythematosus and Loeys-Dietz; however, SCAD has never been known to have a familial association with aortic dissection. Case Summary. This case report describes a 48-year-old woman suffering from SCAD who had a mother who died from ascending aortic dissection in her 50s. Discussion. This is the first case report to our knowledge of a patient with SCAD with a first-degree relative with aortic dissection. Our case is interesting in that it shows that if predisposition to arterial dissection was inherited from mother to daughter, one of them suffered an extremely rare manifestation of their underlying disease. It also shows that a high index of suspicion is needed for SCAD in the presence of a patient with ACS and a family history of dissection elsewhere in the arterial tree.

scholarly journals The Radiologist as a Gatekeeper in Chest Pain

2021 ◽  
Vol 18 (12) ◽  
pp. 6677
Author(s):  
Silvia Pradella ◽  
Giulia Zantonelli ◽  
Giulia Grazzini ◽  
Diletta Cozzi ◽  
Ginevra Danti ◽  
...  
Keyword(s):  
Chest Pain ◽  
Invasive Coronary Angiography ◽  
Patient Characteristics ◽  
Coronary Syndrome ◽  
Aortic Pathology ◽  
Life Threatening ◽  
Ct Technology ◽  
Artery Disease ◽  
Rule Out

Chest pain is a symptom that can be found in life-threatening conditions such as acute coronary syndrome (ACS). Those patients requiring invasive coronary angiography treatment or surgery should be identified. Often the clinical setting and laboratory tests are not sufficient to rule out a coronary or aortic syndrome. Cardiac radiological imaging has evolved in recent years both in magnetic resonance (MR) and in computed tomography (CT). CT, in particular, due to its temporal and spatial resolution, the quickness of the examination, and the availability of scanners, is suitable for the evaluation of these patients. In particular, the latest-generation CT scanners allow the exclusion of diagnoses such as coronary artery disease and aortic pathology, thereby reducing the patient’s stay in hospital and safely selecting patients by distinguishing those who do not need further treatment from those who will need more- or less-invasive therapies. CT additionally reduces costs by improving long-term patient outcome. The limitations related to patient characteristics and those related to radiation exposure are weakening with the improvement of CT technology.

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