Presentations

Abstract

Introduction:

Acute aortic syndrome (AAS) is a life-threatening condition that may present as sudden onset severe chest or back pain, or more insidiously. The incidence of AAS increases with age, and it is more common in people with a history of hypertension, smoking, aortic valve disease, and connective tissue disorders. Early recognition and treatment of AAS are crucial to reduce morbidity and mortality rates associated with this condition.

Case Information:

We present a case series of acute Type A aortic dissections and associated complications.

An 80 year old male patient presented secondary to an acute syncopal episode and chest pain that persisted after the resolution of the syncopal episode. In the emergency department he was found to be tachycardic with mildly elevated troponins and a CTA of the chest, abdomen and pelvis was ordered. This study revealed a Type A aortic dissection involving the arch with acute hemopericardium and concern for tamponade.

A 70 year old female patient presented to the emergency department with sudden onset of chest pain and shortness of breath. A CTA chest pulmonary protocol with associated CT abdomen and pelvis was ordered given an elevated d-dimer. This exam revealed a Type A intramural hematoma originating from the proximal aortic arch and extending to the abdominal aorta. The Type A Intramural hematoma was found to have propagated along the brachiocephalic trunk. The patient underwent graft repair of the aortic arch successfully.

Discussion:

Timely diagnosis of AAS is essential for effective treatment. Computed tomography angiography (CTA) with and without contrast is the preferred imaging test for patients with acute chest pain and suspected AAS. CTA can identify aortic intimal flaps, vessel involvement, PAU, and IMH with high sensitivity and specificity. Other useful imaging modalities which can be used if CTA results are equivocal include magnetic resonance angiography (MRA) and transesophageal echocardiography. Treatment for AAS varies depending on the type and presentation. Type A AAS is a surgical emergency because of the high risk of proximal extension, rupture, and death. Type B AAS can often be managed conservatively with medical therapy, such as blood pressure control and pain management. Endovascular repair may be considered in selected cases of Type B AAS.

Conclusion:

AAS poses a grave threat, demanding swift recognition and treatment. The presented cases underscore the urgency of timely diagnosis using techniques like computed tomography angiography (CTA). Tailored interventions, whether surgical or conservative, highlight the importance of decisive action.