Presentation
Pleuritic chest pain for 4 days.
Patient Data
Extensive Stanford A/DeBakey type I aortic dissection with intimal flap commencing at the level of the aortic root, just distal to the origin of the right carotid artery.
Complex dissection flap throughout the aortic arch extending into the brachiocephalic trunk and the origin of the left subclavian artery. The dissection extends throughout the thoracic and abdominal aorta, reaching the aortic bifurcation and extending into the proximal aspect of the left common iliac artery.
The true lumen throughout the descending thoracic aorta is of significantly smaller caliber than the false lumen. In the abdomen, the true lumen gives rise to the celiac trunk, SMA, IMA and both renal arteries.
Multiple bilateral renal cysts.
Case Discussion
This patient self-presented to the emergency room with a complaint of pleuritic retrosternal chest pain. It was sudden onset four days prior to presentation. He was haemodynamically stable and initially investigated for pulmonary embolus. The aortic dissection was an unexpected surprise!
The patient proceeded to undergo an aortic arch replacement the same day. He will require further intervention to his abdominal dissection; however, did not require acute management as he did not have any gastrointestinal, renal or lower limb ischemia.
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