Limits...
Aortic dissection presenting with secondary pulmonary hypertension caused by compression of the pulmonary artery by dissecting hematoma: a case report.

Kim DH, Ryu SW, Choi YS, Ahn BH - Korean J Radiol (2004 Apr-Jun)

Bottom Line: The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence.No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature.Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea. dhk1107@hanmail.net

ABSTRACT
The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence. No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature. Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension.

Show MeSH

Related in: MedlinePlus

A 64-year-old woman with ascending aortic dissection presenting as secondary pulmonary hypertension.A. An admission chest radiograph shows cardiomegaly with tortuous thoracic aorta, patch infiltration in right lower lobe, and blunting in both costophrenic angles. Mediastinal widening is not definite.B. Preoperative transthoracic echocardiography shows an undulating intimal flap (arrow), dilated ascending aorta, and pericardial effusion (E).C. Preoperative chest CT demonstrates intimal flap (arrow) of ascending aortic dissection (DeBakey type 2), pericardial effusion, and bilateral pleural effusions.D. Chest CT image obtained 1.5 cm above C shows compression of the pulmonary artery by hematoma. Expanding dissection causes aneurysmal dilatation of ascending aorta (4 cm in diameter).E. Schematic drawing in craniocaudal view with cross section of the ascending aorta and pulmonary artery. Right and left pulmonary arteries (rPA & lPA) are severely compressed by the hematoma (H), but coronary ostia are intact. The tear point is E situated at the posterolateral wall (arrow) of the ascending aorta.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2698143&req=5

Figure 1: A 64-year-old woman with ascending aortic dissection presenting as secondary pulmonary hypertension.A. An admission chest radiograph shows cardiomegaly with tortuous thoracic aorta, patch infiltration in right lower lobe, and blunting in both costophrenic angles. Mediastinal widening is not definite.B. Preoperative transthoracic echocardiography shows an undulating intimal flap (arrow), dilated ascending aorta, and pericardial effusion (E).C. Preoperative chest CT demonstrates intimal flap (arrow) of ascending aortic dissection (DeBakey type 2), pericardial effusion, and bilateral pleural effusions.D. Chest CT image obtained 1.5 cm above C shows compression of the pulmonary artery by hematoma. Expanding dissection causes aneurysmal dilatation of ascending aorta (4 cm in diameter).E. Schematic drawing in craniocaudal view with cross section of the ascending aorta and pulmonary artery. Right and left pulmonary arteries (rPA & lPA) are severely compressed by the hematoma (H), but coronary ostia are intact. The tear point is E situated at the posterolateral wall (arrow) of the ascending aorta.

Mentions: A 64-year-old woman with a medical history consisting only of hypertension came to the emergency room (ER) with complaints of chest pain and shortness of breath for 4 days. On admission, she presented with vague discomfort in the right upper abdomen, anterior chest tightness and exertional dyspnea (class III according to the functional classification of the New York Heart Association). Physical examination revealed a blood pressure of 100/80 mmHg, a pulse of 88 beats/min, respiration of 34 breaths/min and a body temperature of 36.2℃. There were crackling sounds in both lower lung fields, but the cardiac sounds were normal. Various laboratory tests were performed on admission, including a blood chemistry profile, coagulation studies and a complete blood count, in which the cardiac enzymes revealed leukocytosis and elevated hepatic enzymes without evidence of myocardial infarction. A chest X-ray taken on admission showed the presence of cardiomegaly without mediastinal widening, patch infiltration in the right lower lobe and blunting of the bilateral costophrenic angles (Fig. 1A). The electrocardiogram disclosed sinus tachycardia of 100 beats/min with no S-T or T wave changes. The Doppler echocardiography revealed an ejection fraction (EF) of 56.4%, moderate to severe tricuspid regurgitation, scanty pericardial effusion and bilateral pleural effusions, hepatic congestion, and an increased systolic pulmonary arterial pressure (SPAP) of 75 mmHg (normal range; 15-30 mmHg), suggesting the presence of severe pulmonary hypertension. After a preliminary diagnosis of "idiopathic right heart failure", the patient was admitted to the medical intensive care unit for treatment. On the 4th day following admission, atrial fibrillation and a sudden drop in systolic blood pressure to 70 mmHg appeared simultaneously. A follow-up transthoracic echocardiography taken 4 days later again showed a dilated ascending aorta and an intimal flap in the proximal ascending aorta (Fig. 1B). The computed tomography (CT) also showed the intimal flap of the ascending aortic dissection (DeBakey type II) and a large amount of hematoma compressing the pulmonary artery (Figs. 1C, D).


Aortic dissection presenting with secondary pulmonary hypertension caused by compression of the pulmonary artery by dissecting hematoma: a case report.

Kim DH, Ryu SW, Choi YS, Ahn BH - Korean J Radiol (2004 Apr-Jun)

A 64-year-old woman with ascending aortic dissection presenting as secondary pulmonary hypertension.A. An admission chest radiograph shows cardiomegaly with tortuous thoracic aorta, patch infiltration in right lower lobe, and blunting in both costophrenic angles. Mediastinal widening is not definite.B. Preoperative transthoracic echocardiography shows an undulating intimal flap (arrow), dilated ascending aorta, and pericardial effusion (E).C. Preoperative chest CT demonstrates intimal flap (arrow) of ascending aortic dissection (DeBakey type 2), pericardial effusion, and bilateral pleural effusions.D. Chest CT image obtained 1.5 cm above C shows compression of the pulmonary artery by hematoma. Expanding dissection causes aneurysmal dilatation of ascending aorta (4 cm in diameter).E. Schematic drawing in craniocaudal view with cross section of the ascending aorta and pulmonary artery. Right and left pulmonary arteries (rPA & lPA) are severely compressed by the hematoma (H), but coronary ostia are intact. The tear point is E situated at the posterolateral wall (arrow) of the ascending aorta.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698143&req=5

Figure 1: A 64-year-old woman with ascending aortic dissection presenting as secondary pulmonary hypertension.A. An admission chest radiograph shows cardiomegaly with tortuous thoracic aorta, patch infiltration in right lower lobe, and blunting in both costophrenic angles. Mediastinal widening is not definite.B. Preoperative transthoracic echocardiography shows an undulating intimal flap (arrow), dilated ascending aorta, and pericardial effusion (E).C. Preoperative chest CT demonstrates intimal flap (arrow) of ascending aortic dissection (DeBakey type 2), pericardial effusion, and bilateral pleural effusions.D. Chest CT image obtained 1.5 cm above C shows compression of the pulmonary artery by hematoma. Expanding dissection causes aneurysmal dilatation of ascending aorta (4 cm in diameter).E. Schematic drawing in craniocaudal view with cross section of the ascending aorta and pulmonary artery. Right and left pulmonary arteries (rPA & lPA) are severely compressed by the hematoma (H), but coronary ostia are intact. The tear point is E situated at the posterolateral wall (arrow) of the ascending aorta.
Mentions: A 64-year-old woman with a medical history consisting only of hypertension came to the emergency room (ER) with complaints of chest pain and shortness of breath for 4 days. On admission, she presented with vague discomfort in the right upper abdomen, anterior chest tightness and exertional dyspnea (class III according to the functional classification of the New York Heart Association). Physical examination revealed a blood pressure of 100/80 mmHg, a pulse of 88 beats/min, respiration of 34 breaths/min and a body temperature of 36.2℃. There were crackling sounds in both lower lung fields, but the cardiac sounds were normal. Various laboratory tests were performed on admission, including a blood chemistry profile, coagulation studies and a complete blood count, in which the cardiac enzymes revealed leukocytosis and elevated hepatic enzymes without evidence of myocardial infarction. A chest X-ray taken on admission showed the presence of cardiomegaly without mediastinal widening, patch infiltration in the right lower lobe and blunting of the bilateral costophrenic angles (Fig. 1A). The electrocardiogram disclosed sinus tachycardia of 100 beats/min with no S-T or T wave changes. The Doppler echocardiography revealed an ejection fraction (EF) of 56.4%, moderate to severe tricuspid regurgitation, scanty pericardial effusion and bilateral pleural effusions, hepatic congestion, and an increased systolic pulmonary arterial pressure (SPAP) of 75 mmHg (normal range; 15-30 mmHg), suggesting the presence of severe pulmonary hypertension. After a preliminary diagnosis of "idiopathic right heart failure", the patient was admitted to the medical intensive care unit for treatment. On the 4th day following admission, atrial fibrillation and a sudden drop in systolic blood pressure to 70 mmHg appeared simultaneously. A follow-up transthoracic echocardiography taken 4 days later again showed a dilated ascending aorta and an intimal flap in the proximal ascending aorta (Fig. 1B). The computed tomography (CT) also showed the intimal flap of the ascending aortic dissection (DeBakey type II) and a large amount of hematoma compressing the pulmonary artery (Figs. 1C, D).

Bottom Line: The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence.No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature.Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea. dhk1107@hanmail.net

ABSTRACT
The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence. No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature. Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension.

Show MeSH
Related in: MedlinePlus