Figure 3: The final chest X-ray turned out to show total haziness of left thorax.

Mentions: The physical examination revealed rapid and shallow heart sounds. The heart rate was 120/minute, the initial blood pressure (BP) was high, 150/90 mmHg in both arms, the respiration rate was 25/minute, and the body temperature was 36.8℃. Laboratory testing revealed a hemoglobin of 13.4 g/dL; a platelet count of 446,000/uL; Cardiac enzymes and serum electrolytes including Na+, K+, Ca++, phosphate were all normal. The electrocardiogram showed sinus tachycardia. The chest X-ray was normal (Fig. 1). The trans-thoracic echocardiography revealed a normal cardiac structure with normal systolic and diastolic function. To decrease the high BP and rapid heart rate, an IV beta-blocker was infused. The patient had no history of hypertension. Despite stabilizing the BP and heart rate, the sharp chest pain persisted at the mid-sternum and extended to the abdomen. Thus an aortic dissection was suspected and emergency computed tomography (CT) scanning of the chest and abdomen was performed. The diagnosis of aortic dissection was established by CT imaging from the visualization of a torn intimal flap noted from the left subclavian artery to the left common iliac artery (Fig. 2A). There was impending luminal obstruction of the left iliac artery due to the extension of the dissection (Fig. 2B and C). Treatment with intravenous esmolol and nitroprusside was started in the intensive care unit and his BP improved to 120/75 mmHg, the heart rate was normalized to 75/minute, and the chest pain was controlled with an intravenous morphine infusion. The patient was sent to surgery immediately. While waiting for the emergency operation, the eyes deviated and seizures developed with loss of consciousness. A cardiac arrest followed. A chest X-ray, taken immediately, demonstrated left lung haziness (Fig. 3) which was likely due to the sudden rupture of the aortic dissection.

Jo YJ, Lee EJ, Oh JW, Moon CM, Cho DK, Cho YH, Byun KH, Eun LY - Korean Circ J (2011)

Bottom Line: The diagnosis of aortic dissection type B was established by CT imaging.He died prior to surgery due to aortic rupture.Here we present this rare case of aortic dissection type B with rupture, reported in an 11-year-old Korean child.

Affiliation: Department of Pediatric Cardiology, Kwandong University Myongji Hospital Cardiovascular Center, Goyang, Korea.

Abstract: After developing sudden severe chest pain, an 11-year-old boy presented to the emergency room with chest pain and palpitations and was unable to stand up. The sudden onset of chest pain was first reported while swimming at school about 30 minutes prior to presentation. Arterial blood pressure (BP) was 150/90 mmHg, heart rate was 120/minute, and the chest pain was combined with shortness of breath and diaphoresis. During the evaluation in the emergency room, the chest pain worsened and abdominal pain developed. An aortic dissection was suspected and a chest and abdomen CT was obtained. The diagnosis of aortic dissection type B was established by CT imaging. The patient went to surgery immediately with BP control. He died prior to surgery due to aortic rupture. Here we present this rare case of aortic dissection type B with rupture, reported in an 11-year-old Korean child.