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A penetrating atherosclerotic ulcer rupture in the ascending aorta with hemopericardium: a case report.

Liu YH, Ke HY, Lin YC, Tsai CS - J Cardiothorac Surg (2016)

Bottom Line: An electrocardiogram did not show an ST segment elevation, and cardiac enzymes were within normal limits.No widening mediastinum was found on chest radiography, but a large pericardial effusion with an impending cardiac tamponade was revealed on echocardiography.However, we anticipate that endovascular repair may become feasible in patients with PAU in the ascending aorta in the future.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, Republic of China.

ABSTRACT

Background: Acute aortic syndrome, including classic aortic dissection, intramural aortic hematoma, and penetrating atherosclerotic ulcer (PAU), is a term used to describe a group of conditions with similar clinical symptoms, but with different pathophysiological mechanisms. PAU is a lesion that penetrates the internal elastic lamina through the media. It is usually located in the descending aorta and rarely observed in the ascending aorta.

Case presentation: A 76-year-old man with a history of essential hypertension was brought to the emergency department (ED) because of a sudden-onset chest pain at rest. He had not been taking his medication as ordered. His vital signs in the ED were a blood pressure of 82/60 mmHg, heart rate of 158 beats per min, respiratory rate of 22 breaths per min, and a body temperature of 37.2 °C. An electrocardiogram did not show an ST segment elevation, and cardiac enzymes were within normal limits. No widening mediastinum was found on chest radiography, but a large pericardial effusion with an impending cardiac tamponade was revealed on echocardiography. The diagnosis of PAU rupture in the ascending aorta with hemopericardium was made with chest computed tomography. An emergent sternotomy and ascending aorta reconstruction were performed. A ruptured ulcerative plaque through the intima to the adventitia without flap dissection in the ascending aorta was confirmed. The patient was discharged 18 days after the operation.

Conclusions: Although PAU in the ascending aorta is uncommon, it is commonly lethal when it ruptures. With the current advances in endovascular techniques and devices, endovascular repair of PAU in the ascending aorta is currently recommended only for high-risk patients unsuitable for open repair. However, we anticipate that endovascular repair may become feasible in patients with PAU in the ascending aorta in the future.

No MeSH data available.


Related in: MedlinePlus

A protruding spot (PAU) in the ascending aorta, axial view (red arrow)
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Fig2: A protruding spot (PAU) in the ascending aorta, axial view (red arrow)

Mentions: A 76-year-old man with a history of essential hypertension, who had not been taking his medications before this admission, presented to the emergency department (ED) because of a sudden chest pain at rest. His vital signs in the ED were a blood pressure of 82/60 mmHg, heart rate of 158 beats per min, respiratory rate of 22 breaths per min, and a body temperature of 37.2 °C. Electrocardiogram did not show an ST segment elevation, and cardiac enzymes were within normal limits. No widening mediastinum was found on chest radiography, but echocardiography revealed a large pericardial effusion with impending cardiac tamponade. Ruptured PAU of the ascending aorta with hemopericardium was diagnosed with chest CT scan (Figs. 1 and 2). A ruptured ulcer plaque through the intima to the adventitia without flap dissection in the ascending aorta was confirmed. An emergent sternotomy and ascending aorta reconstruction were performed. The postoperative recovery was uneventful, and the patient was discharged 18 days after the operation.Fig. 1


A penetrating atherosclerotic ulcer rupture in the ascending aorta with hemopericardium: a case report.

Liu YH, Ke HY, Lin YC, Tsai CS - J Cardiothorac Surg (2016)

A protruding spot (PAU) in the ascending aorta, axial view (red arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940843&req=5

Fig2: A protruding spot (PAU) in the ascending aorta, axial view (red arrow)
Mentions: A 76-year-old man with a history of essential hypertension, who had not been taking his medications before this admission, presented to the emergency department (ED) because of a sudden chest pain at rest. His vital signs in the ED were a blood pressure of 82/60 mmHg, heart rate of 158 beats per min, respiratory rate of 22 breaths per min, and a body temperature of 37.2 °C. Electrocardiogram did not show an ST segment elevation, and cardiac enzymes were within normal limits. No widening mediastinum was found on chest radiography, but echocardiography revealed a large pericardial effusion with impending cardiac tamponade. Ruptured PAU of the ascending aorta with hemopericardium was diagnosed with chest CT scan (Figs. 1 and 2). A ruptured ulcer plaque through the intima to the adventitia without flap dissection in the ascending aorta was confirmed. An emergent sternotomy and ascending aorta reconstruction were performed. The postoperative recovery was uneventful, and the patient was discharged 18 days after the operation.Fig. 1

Bottom Line: An electrocardiogram did not show an ST segment elevation, and cardiac enzymes were within normal limits.No widening mediastinum was found on chest radiography, but a large pericardial effusion with an impending cardiac tamponade was revealed on echocardiography.However, we anticipate that endovascular repair may become feasible in patients with PAU in the ascending aorta in the future.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, Republic of China.

ABSTRACT

Background: Acute aortic syndrome, including classic aortic dissection, intramural aortic hematoma, and penetrating atherosclerotic ulcer (PAU), is a term used to describe a group of conditions with similar clinical symptoms, but with different pathophysiological mechanisms. PAU is a lesion that penetrates the internal elastic lamina through the media. It is usually located in the descending aorta and rarely observed in the ascending aorta.

Case presentation: A 76-year-old man with a history of essential hypertension was brought to the emergency department (ED) because of a sudden-onset chest pain at rest. He had not been taking his medication as ordered. His vital signs in the ED were a blood pressure of 82/60 mmHg, heart rate of 158 beats per min, respiratory rate of 22 breaths per min, and a body temperature of 37.2 °C. An electrocardiogram did not show an ST segment elevation, and cardiac enzymes were within normal limits. No widening mediastinum was found on chest radiography, but a large pericardial effusion with an impending cardiac tamponade was revealed on echocardiography. The diagnosis of PAU rupture in the ascending aorta with hemopericardium was made with chest computed tomography. An emergent sternotomy and ascending aorta reconstruction were performed. A ruptured ulcerative plaque through the intima to the adventitia without flap dissection in the ascending aorta was confirmed. The patient was discharged 18 days after the operation.

Conclusions: Although PAU in the ascending aorta is uncommon, it is commonly lethal when it ruptures. With the current advances in endovascular techniques and devices, endovascular repair of PAU in the ascending aorta is currently recommended only for high-risk patients unsuitable for open repair. However, we anticipate that endovascular repair may become feasible in patients with PAU in the ascending aorta in the future.

No MeSH data available.


Related in: MedlinePlus