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Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2021 June;180(6):312-5

DOI: 10.23736/S0393-3660.19.04256-6


language: English

A successful case of aortic intramural hematoma with type-A aortic dissection: symptoms first

Vanessa M. CHAVES 1 , Catarina G. PEREIRA 2, Carlos X. RESENDE 3, Sofia F. TAVARES 1, Clara F. GOMES 1, Pedro S. RODRIGUES 1, José L. PINHEIRO TORRES 4, Pedro VON HAFE 1

1 Department of Internal Medicine, São João University Hospital, Porto, Portugal; 2 Department of Internal Medicine, Vila Nova de Gaia/Espinho Hospital, Vila Nova de Gaia, Portugal; 3 Department of Cardiology, São João University Hospital, Porto, Portugal; 4 Department of Cardiothoracic Surgery, São João University Hospital, Porto, Portugal

Acute aortic syndromes (AAS) are life-threatening conditions that can be often overlooked due to its rarity and wide array of differential diagnosis. We reported the case of a hypertensive 66-year-old woman presenting in the emergency department with syncope followed by acute installation of neurological deficits. Brain computed tomography excluded stroke or intracerebral hemorrhage. Arrhythmic event, acute coronary syndrome and pulmonary embolism were excluded by adequate investigation. Computed tomography pulmonary angiography showed moderate pericardial effusion, an elevated caliber of the aorta and a hypodensity in the aortic root. The finding of pericardial effusion, subsequently confirmed on echocardiogram, was thought to be the underlying cause of the symptoms and the patient was admitted with syncope and pericardial effusion for additional study. In the first hospitalization day she described having an abrupt tearing interscapular pain just before syncope installation. Considering the high suspicion of AAS, the patient was immediately admitted in cardiothoracic operating room. There was confirmation of intramural hematoma with aortic dissection, and she was submitted to surgical correction, presenting a favorable clinical outcome. The patient has been followed for 4 years, remaining asymptomatic, without imagological evidence of dissection. This case exemplifies the diagnostic challenge of AAS and emphasizes that symptoms recognition is mandatory for a timely diagnosis and treatment.

KEY WORDS: Chest pain; Hematoma; Aorta; Aneurysm, dissecting

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