Motta-Ramírez GA, González-Merino LI, Ruiz-Castro E, Rodríguez-Treviño C, Amézquita-Pérez S

Language: Spanish
References: 18
Page: 8-20
PDF size: 528.90 Kb.

ABSTRACT

Introduction. Acute aortic dissection (AAD) is an uncommon but potentially catastrophic illness with high mortality; begins with a tear in the aortic intima and inner layer of the aortic media allowing blood to enter and split the aortic media. This process is responsible for the formation of true and false lumen separated by the intimal flap. About 65% of dissections originate in the ascending aorta, 20% in the descending thoracic aorta, 10% in the aortic arch, and the remainder in the abdominal aorta.
Purpose. AAD are among the trickiest of diagnoses and often result in death. The new imaging techniques allow better and earlier diagnosis of aortic diseases even in emergency situations. These new imaging techniques specifically CTA have changed patient management during recent years, allowing more rapid diagnosis and decision making. The radiologist must be especially sensitive, because is capable to identified AAD without clinical clues and need to be aware to get an early diagnosis.
Materials and methods. Studies of patients with CTA April, 2005 to August, 2012 in which were identified AAD was included. Clinical and radiological correlation with those undergoing surgery compared with management by invasive radiology stenting. Their records were reviewed. All cases were characterized according to the classifications of DeBakey and Stanford.
Results. In this retrospective review which included 7 years 4 months, 21 patients were identified 7 women (33%) and 14 men (67%); the image pattern and the diagnosis was established with integration according to classifications DeBakey and Stanford. According to the DeBakey classification: type I, 12 patients (57 %) type II, 3 patients (14 %) and type III, 6 patients (29%). Classification of aortic dissection Stanford type A, 14 patients (67%) and type B, 7 patients (33%). The range of ages fluctuated between 32 and 82 years, mean age 69 years. The risk factors of AAD, such as identification of AAT, 10 patients (48 %) and AAA, 5 patients (24 %) were defined. In 6 patients, no risk factors were identified until after the identification of the AAD by the imaging study in 4 patients (19 %) with chest pain, exertional angina and hypertension poorly controlled, in one of these patients with suspected pulmonary thromboembolism; in the remaining 4 patients (19 %) the finding by the DAA image was incidental.
Conclusions. AAD is the most common emergency affecting the aorta. CTA is useful in identifying the intimal flap, the extent of the dissection, branch vessel involvement, the size of the aorta, the patency of false lumen, and pericardial effusion and can visualize proximal coronary arteries. The clinical progress of these patients is unpredictable and, in many cases, unfavourable. Therefore, an early diagnosis is essential. The diagnosis of AAD should be considered in the differential diagnosis of patients presenting in the emergency room with myocardial ischemia, syncope, chest pain, back pain, abdominal pain, stroke, and acute heart failure.

REFERENCES

1. Braverman AC. Acute aortic dissection: clinician update. Circulation 2010; 122: 184-8.

2. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The international registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA 2000; 283: 897-903.

3. Chen K, Varon J, Wenker OC, Judge DK, Fromm Jr RE, Sternbach GL. Acute thoracic aortic dissection: the basics. J Emerg Med 1997; 15: 859-67.

4. Trainini JC. Consenso de patología de la aorta. Revista Argentina De Cardiología 2004; 72(5): 387-401. Disponible en: http://www.sac.org.ar/files/files/72-5-13.pdf

5. Sueyoshi E, Nagayama H, Hayashida T, Sakamoto I, Uetani M. Comparison of outcome in aortic dissection with single false lumen versus multiple false lumens: CT assessment. Radiology 2013; 267: 368-75.

6. Thoongsuwan N, Stern EJ. Chest CT scanning for clinical suspected thoracic aortic dissection: beware the alternate diagnosis. Emerg Radiol 2002; 9: 257-61.

7. Erbel F, Alfonso C, Boileau O, et al. Diagnosis and management of aortic dissection: Task Force on Aortic Dissection, European Society of Cardiology. Eur Heart J 2001; 22: 1642-81.

8. Shirakabe A, Hata N, Yokoyama S, Shinada T, Suzuki Y, Kobayashi N, Kikuchi A, et al. Diagnostic score to differentiate acute aortic dissection in the emergency room. Circ J 2008; 72(6): 986-90.

9. Zamorano JL, Pérez de Isla L, González R, Almería C, Rodrigo JL. Diagnóstico por imagen en el síndrome aórtico agudo. Rev Esp Cardiol 2003; 56(5): 498-508.

10. Santini F, Mazzucco A. Acute type A aortic dissection: an update on a still challenging disease. J Cardiovasc Med 2007; 8(2): 102-7.

11. Upadhye S, Schiff K. Acute aortic dissection in the emergency department: diagnostic challenges and evidence- based management. Emerg Med Clin N Am 2012; 30: 307-27.

12. Disponible en: http://www.slideshare.net/betomotta/vomit- barf-1143418

13. Algieri RD, Ferrante MS, Merola C, Sarti L, D’Amore V, Viglione F. Evento adverso en el diagnóstico de disección aórtica torácica por TAC. Hosp Aeronáut Cent 2012; 7(1): 51-3.

14. Schulenburg M. Management of hypertensive emergencies: implications for the critical care nurse. Crit Care Nurs Q 2007; 30(2): 86-93.

15. Contreras-Zúñiga E, Zuluaga-Martínez SX, Gómez- Mesa JE, Ocampo Duque V, Urrea Zapata CA. Diseccion aórtica: estado actual. Rev Costarr Cardiol 2009; 11(1): 19-27.

16. Batra P, Bigoni B, Manning J, Aberle DR, Brown K, Hart E, Goldin J. Pitfalls in the diagnosis of thoracic aortic dissection at CT angiography. Radiographics 2000; 20: 309-20.

17. Svensson LG, Labib SB, Eisenhauser AC, Butter?y JR. Intimal tear without haematoma. Circulation 1999; 99: 1331-6.

18. Ince H, Nienaber CA. Tratamiento de los síndromes aórticos agudos. Rev Esp Cardiol 2007; 60(5): 526-41.