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The utility of multiple imaging modalities to diagnose acute aortic dissection

Published online by Cambridge University Press:  21 May 2015

Katrina F. Hurley*
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
James Ducharme
Affiliation:
Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ont.
*
Emergency Department, QEII, Halifax Infirmary — Rm 3021, 1796 Summer St., Halifax NS B3H 3A7; [email protected]

Abstract

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A 21-year-old man with Marfan syndrome and known aortic root aneurysm presented to our emergency department with symptoms suggestive of acute aortic dissection. The patient was hemodynamically stable and bilateral upper extremity blood pressures were similar. There was no mediastinal widening on portable chest radiograph. Both contrast CT and retrograde angiography of the aorta failed to identify dissection. Subsequent transesophageal echocardiography demonstrated a Stanford classification type A dissection. This case demonstrates the utility of multiple imaging modalities for identifying aortic dissection in high-risk patients.

Résumé

RÉSUMÉ

Un jeune homme de 21 ans atteint du syndrome de Marfan avec présence connue d'un anévrisme de la racine aortique s'est présenté à l'urgence avec des symptômes évoquant une dissection aiguë de l'aorte. Le patient était stable sur le plan hémodynamique et les pressions artérielles bilatérales des membres supérieurs étaient similaires. Les résultats de la radiographie pulmonaire réalisée sur un appareil portatif n'indiquaient pas d'élargissement du médiastin. Ni la tomodensitométrie avec agent de contraste ni l'angiographie rétrograde de l'aorte n'ont permis de déceler la dissection. Une échocardiographie transœsophagienne subséquente a montré qu'il s'agissait d'une dissection de type A selon la classification de Stanford. Ce cas met en évidence l'utilité d'avoir recours à de multiples techniques d'imagerie médicale pour établir un diagnostic de dissection aortique chez les patients à haut risque.

Type
Case Report • Rapport de cas
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1. Robicsek, F, Thubrikar, MJ. Hemodynamic considerations regarding the mechanism and prevention of aortic dissection. Ann Thorac Surg 1994;58:1247–53.Google Scholar
2. Spittell, PC, Spittell, JA Jr, Joyce, JW, et al. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clin Proc 1993;68:642–51.Google Scholar
3. Hirst, AE Jr, Johns, VJ Jr, Kime, SW Jr. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958;37:217–79.Google Scholar
4. Hagan, PG, Nienaber, CA, Isselbacher, EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000;283:897903.Google Scholar
5. Januzzi, JL, Marayati, F, Mehta, RH, et al. Comparison of aortic dissection in patients with and without Marfan’s syndrome (results from the International Registry of Aortic Dissection). Am J Cardiol 2004;94:400–2.Google Scholar
6. Bentall, HH. Operation for ascending aortic aneurysm and aortic regurgitation — pathological influence on survival. Jpn J Surg 1987;17:425–30.Google Scholar
7. Erbel, R, Engberding, R, Daniel, W, et al. Echocardiography in diagnosis of aortic dissection. Lancet 1989;1:457–61.Google Scholar
8. Nienaber, CA, Spielmann, RP, von Kodolitsch, Y, et al. Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography. Circulation 1992;85:434–47.Google Scholar
9. Nienaber, CA, von Kodolitsch, Y, Brockhoff, CJ, et al. Comparison of conventional and transesophageal echocardiography with magnetic resonance imaging for anatomical mapping of thoracic aortic dissection. A dual noninvasive imaging study with anatomical and/or angiographic validation. Int J Card Imaging 1994;10:114.Google Scholar
10. Chirillo, F, Cavallini, C, Longhini, C, et al. Comparative diagnostic value of transesophageal echocardiography and retrograde aortography in the evaluation of thoracic aortic dissection. Am J Cardiol 1994;74:590–5.Google Scholar
11. Sommer, T, Fehske, W, Holzknecht, N, et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography and MR imaging. Radiology 1996;199:347–52.Google Scholar
12. Small, JH, Dixon, AK, Coulden, RA, et al. Fast CT for aortic dissection. Br J Radiol 1996;69:900–5.Google Scholar
13. Keren, A, Kim, CB, Hu, BS, et al. Accuracy of biplane and multiplane transesophageal echocardiography in diagnosis of typical acute aortic dissection and intramural hematoma. J Am Coll Cardiol 1996;28:627–36.Google Scholar
14. Evangelista, A, Garcia-del-Castillo, H, Gonzalez-Alujas, T, et al. Diagnosis of ascending aortic dissection by transesophageal echocardiography: utility of M-mode in recognizing artifacts. J Am Coll Cardiol 1996;27:102–7.Google Scholar
15. von Kodolitsch, Y, Simic, O, Nienaber, CA. Aneurysms of the ascending aorta: diagnostic features and prognosis in patients with Marfan’s syndrome versus hypertension. Clin Cardiol 1998;21:817–24.Google Scholar
16. Kodolitsch, Y, Krause, N, Spielmann, R, et al. Diagnostic potential of combined transthoracic echocardiography and x-ray computed tomography in suspected aortic dissection. Clin Cardiol 1999;22:345–52.Google Scholar
17. Pepi, M, Campodonico, J, Galli, C, et al. Rapid diagnosis and management of thoracic aortic dissection and intramural haematoma: a prospective study of advantages of multiplane vs. biplane transoesophageal echocardiography. Eur J Echocardiogr 2000;1:72–9.Google Scholar
18. Hayter, RG, Rhea, JT, Small, A, et al. Suspected aortic dissection and other aortic disorders: multi-detector row CT in 373 cases in the emergency setting. Radiology 2006;238:841–52.Google Scholar
19. Losi, MA, Betocchi, S, Briguori, C, et al. Determinants of aortic artifacts during transesophageal echocardiography of the ascending aorta. Am Heart J 1999;137:967–72.Google Scholar
20. Vignon, P, Spencer, KT, Rambaud, G, et al. Differential transesophageal echocardiographic diagnosis between linear artifacts and intraluminal flap of aortic dissection or disruption. Chest 2001;119:1778–90.Google Scholar
21. Wiet, SP, Pearce, WH, McCarthy, WJ, et al. Utility of transesophageal echocardiography in the diagnosis of disease of the thoracic aorta. J Vasc Surg 1994;20:613–20.Google Scholar
22. Mastrogiovanni, G, Masiello, P, Leone, R, et al. Emergency surgical management of acute aortic dissection: role of transesophageal echocardiography. G Ital Cardiol 1999;29:1137–41.Google Scholar
23. Silvey, SV, Stoughton, TL, Pearl, W, et al. Rupture of the outer partition of aortic dissection during transesophageal echocardiography. Am J Cardiol 1991;68:286–7.Google Scholar
24. Moore, AG, Eagle, KA, Bruckman, D, et al. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). Am J Cardiol 2002;89:1235–8.Google Scholar
25. Nitatori, T, Yokoyama, K, Nakamura, A, et al. Clinical application of single shot GRE-EPI as non-enhanced MRA (EPI-MRA) for aortic aneurysm and dissection. Radiat Med 1999;17:393–7.Google Scholar
26. Summers, RM, Sostman, HD, Spritzer, CE, et al. Fast spoiled gradient-recalled MR imaging of thoracic aortic dissection: preliminary clinical experience at 1.5 T. Magn Reson Imaging 1996;14:19.Google Scholar
27. Kersting-Sommerhoff, BA, Higgins, CB, White, RD, et al. Aortic dissection: sensitivity and specificity of MR imaging. Radiology 1988;166:651–5.Google Scholar
28. Shiga, T, Wajima, Z, Apfel, CC, et al. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: Systematic review and meta-analysis. Arch Intern Med 2006;166:1350–6.Google Scholar
29. Egger, M, Smith, GD. Misleading meta-analysis. BMJ 1995;310:752–4.Google Scholar
30. Sarasin, FP, Louis-Simonet, M, Gaspoz, JM, et al. Detecting acute thoracic aortic dissection in the emergency department: time constraints and choice of the optimal diagnostic test. Ann Emerg Med 1996;28:278–88.Google Scholar
31. Barbant, SD, Eisenberg, MJ, Schiller, NB. The diagnostic value of imaging techniques for aortic dissection. Am Heart J 1992;124:541–3.Google Scholar