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The utility of multiple imaging modalities to diagnose acute aortic dissection

Published online by Cambridge University Press:  21 May 2015

Katrina F. Hurley  and
James Ducharme
Katrina F. Hurley*
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
James Ducharme
Affiliation:
Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ont.
*
Emergency Department, QEII, Halifax Infirmary — Rm 3021, 1796 Summer St., Halifax NS B3H 3A7; kfhurley@dal.ca

Abstract

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A 21-year-old man with Marfan syndrome and known aortic root aneurysm presented to our emergency department with symptoms suggestive of acute aortic dissection. The patient was hemodynamically stable and bilateral upper extremity blood pressures were similar. There was no mediastinal widening on portable chest radiograph. Both contrast CT and retrograde angiography of the aorta failed to identify dissection. Subsequent transesophageal echocardiography demonstrated a Stanford classification type A dissection. This case demonstrates the utility of multiple imaging modalities for identifying aortic dissection in high-risk patients.

Résumé

RÉSUMÉ

Un jeune homme de 21 ans atteint du syndrome de Marfan avec présence connue d'un anévrisme de la racine aortique s'est présenté à l'urgence avec des symptômes évoquant une dissection aiguë de l'aorte. Le patient était stable sur le plan hémodynamique et les pressions artérielles bilatérales des membres supérieurs étaient similaires. Les résultats de la radiographie pulmonaire réalisée sur un appareil portatif n'indiquaient pas d'élargissement du médiastin. Ni la tomodensitométrie avec agent de contraste ni l'angiographie rétrograde de l'aorte n'ont permis de déceler la dissection. Une échocardiographie transœsophagienne subséquente a montré qu'il s'agissait d'une dissection de type A selon la classification de Stanford. Ce cas met en évidence l'utilité d'avoir recours à de multiples techniques d'imagerie médicale pour établir un diagnostic de dissection aortique chez les patients à haut risque.

Keywords

aortic dissectionangiographytransesophageal echocardiogramcomputed tomographymagnetic resonance imagingMarfan syndrome
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 1 , January 2008 , pp. 75 - 80
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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