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Attridge MM, Hopkins KA, Mangold K, Brickman WJ, Patel SR. Diagnosis and Management of Aortic Dissection in a Pediatric Patient With Turner Syndrome: A Simulation. Cureus 2023; 15:e41725. [PMID: 37575692 PMCID: PMC10414799 DOI: 10.7759/cureus.41725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Aortic dissection is exceedingly rare in the pediatric population. However, it is much more common among children and adolescents with certain underlying syndromes, including Turner syndrome. Furthermore, aortic dissection carries significant mortality without prompt diagnosis and management. Therefore, pediatric emergency providers should know how to recognize and treat pediatric aortic dissection in a patient with Turner syndrome. We designed this simulation for pediatric emergency medicine fellows. A simulated adolescent female patient with a known history of Turner syndrome presents with chest pain, tachycardia, and hypertension. Participants must order and interpret the appropriate diagnostics, diagnose aortic dissection, and manage aortic dissection adequately. This simulation was completed by six pediatric emergency medicine fellows and one pediatric resident. After completing the simulation, six participants (85.7%) provided anonymous feedback on a five-point Likert scale (one = strongly disagree, five = strongly agree). Feedback was positive, and participants agreed that the case content was relevant to their clinical practice and that the event will improve their clinical practice. This simulation encourages participants to recognize and manage pediatric aortic dissection in patients with Turner syndrome. Participants felt that the simulation was relevant and will improve their clinical practice.
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Affiliation(s)
- Megan M Attridge
- Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Kali A Hopkins
- Adult Congenital Cardiology, Division of Cardiology, Mount Sinai Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Karen Mangold
- Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Wendy J Brickman
- Pediatric Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Sheetal R Patel
- Pediatric Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
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Computed tomography for aortic assessment in children. Pediatr Radiol 2022; 52:2470-2484. [PMID: 36151220 DOI: 10.1007/s00247-022-05501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
Because the aorta is the major vessel of the body, basic knowledge of aortic pathology is essential to the pediatric imager. This review divides aortic pathology into anatomical (e.g., congenital abnormalities) and acquired (e.g., vasculitis, trauma) entities, providing a brief description of pathology, technical considerations in CT acquisition and processing, and some pearls and pitfalls of interpretation. The objective of this paper is to familiarize general pediatric imagers with imaging features of common as well as high-impact aortic pathology on CT and prepare them for acquisition and reporting.
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Matsushita H, Omiya H, Uehara K, Takatori M. Management of an 11-year-old patient who presented with acute aortic dissection. J Cardiol Cases 2021; 24:72-74. [PMID: 34354781 DOI: 10.1016/j.jccase.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/11/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022] Open
Abstract
An 11-year-old boy with no medical or family history was diagnosed with Stanford type B acute aortic dissection. Although a conservative treatment approach was adopted, deep sedation was required to keep him still during computed tomography. It revealed enlargement of the false lumen of the descending aorta, bilateral pleural effusion, and atelectasis. Thus, he underwent descending aortic replacement. After amelioration of perioperative rhabdomyolysis, he was discharged post-recovery. Since there have been no clinical guidelines for management of pediatric aortic dissection, it was difficult to decide between surgical and conservative approaches. Considering difficulty of mild sedation in children, if conservative approaches seem to be problematic, an early surgical approach with aortic replacement is sometimes necessary. <Learning objective: Acute aortic dissection rarely occurs in children or adolescents. There have been no clinical guidelines for management of pediatric aortic dissection. Therefore, it is difficult to decide between surgical and conservative approaches. Considering difficulty of mild sedation in children, if conservative approaches seem to be problematic, an early surgical approach might be effective.>.
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Affiliation(s)
| | - Hiroki Omiya
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kenji Uehara
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Makoto Takatori
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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Baturone Blanco A, Martín Conejero A, Rial Horcajo R, Hernández Mateo MM, Pla Sánchez F, Uclés Cabeza Ó, Serrano Hernando FJ. Aortic Rupture by an Acute Dissection of the Thoracoabdominal Aorta in a 12-Year-Old Boy. Ann Vasc Surg 2021; 75:532.e9-532.e13. [PMID: 33836231 DOI: 10.1016/j.avsg.2021.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 02/04/2023]
Abstract
Aortic dissection is exceptional in children. When they are affected, many clinical conditions as Marfan syndrome or Ehlers-Danlos syndrome are usually involved, but up to 22% have no associated background. Its high morbidity and low incidence in this age group require a high level of suspicion in children without predisposing factors when the presentation is atypical, to avoid the severe consequences of the delay of their diagnosis. In this article we describe the dissection and aortic rupture in a 12-year-old child without relevant medical history, and the open repair that was performed as treatment.
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Affiliation(s)
- Adriana Baturone Blanco
- Physician in the Angiology and Vascular Surgery Department, San Carlos Clinical Hospital, Madrid.
| | - Antonio Martín Conejero
- Physician in the Angiology and Vascular Surgery Department, San Carlos Clinical Hospital, Madrid
| | - Rodrigo Rial Horcajo
- Physician in the Angiology and Vascular Surgery Department, San Carlos Clinical Hospital, Madrid
| | | | - Ferrán Pla Sánchez
- Physician in the Angiology and Vascular Surgery Department, San Carlos Clinical Hospital, Madrid
| | - Óscar Uclés Cabeza
- Physician in the Angiology and Vascular Surgery Department, San Carlos Clinical Hospital, Madrid
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Evangelista A, Teixidó-Tura G. Sudden Cardiovascular Death in Young Patients With Aortic Dissection. What Lessons Should We Learn? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:528-530. [PMID: 30956035 DOI: 10.1016/j.rec.2019.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Arturo Evangelista
- Institut de Recerca del Hospital Vall d'Hebron, Servicio de Cardiología del Hospital Universitari Vall d'Hebron, CIBERCV, Barcelona, Spain.
| | - Gisela Teixidó-Tura
- Institut de Recerca del Hospital Vall d'Hebron, Servicio de Cardiología del Hospital Universitari Vall d'Hebron, CIBERCV, Barcelona, Spain
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Hauck A, Camarda J. Rare Cardiac Emergencies: Aortic Dissection, Pulmonary Hypertensive Crisis, and Pulmonary Embolism. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Cystinosis is a rare, autosomal-recessive genetic disorder. The kidneys are commonly involved, as there is cystinosin protein malfunction, and nephropathic cystinosis ensues. Although cardiac and vascular involvements are rare, we describe a unique case of aortic dissection in a 25-year-old female with cystinosis. We discuss the possible aetiologies of aortic dissection in this condition.
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Abstract
Echocardiography is the primary modality for imaging the aorta for the diagnosis and serial evaluation of pathological conditions. In this article, we review the methodology for optimal echocardiographic imaging of the various segments of the aorta and discuss abnormalities of the aorta including stenosis, dilation including aortopathy and sinus of Valsalva aneurysms, and fistulous communications involving the ascending aorta including aortoventricular tunnel and ruptured sinus of Valsalva aneurysm. We review novel echocardiographic measurements of aortic functional properties of the aorta such as elasticity and stiffness, and review the literature on the potential additive value of such measurements for structural assessment alone. Finally, we discuss the limitations of echocardiography in the precise and optimal imaging of the aorta.
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Xu Y, Treumann S, Rossbacher R, Schneider S, Boor PJ. Dissecting aortic aneurysm induced by N-(2-aminoethyl) ethanolamine in rat: Role of defective collagen during development. ACTA ACUST UNITED AC 2014; 100:924-33. [PMID: 24909928 DOI: 10.1002/bdra.23260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Dissecting aortic aneurysm (DAA) is a tear in the wall of the aorta that causes blood to flow, or "dissect," between the medial layers of the media. METHODS Pregnant rats (dams) were treated with the industrial chemical n-(2-aminoethyl) ethanolamine (AEEA) by intraperitoneal injection or gavage. The histology and pathology of aorta in the thorax from newborn pups were examined. Aortas of fetuses of gestational day 20 from dams exposed to AEEA were harvested for immunohistochemical staining and native Western blot to study the changes of collagen type 1 and type 3 in aorta. RESULTS Dissecting aortic aneurysm of newborn rats was induced by treating with AEEA through intraperitoneal injection or gavage. The incidence of DAA reached 100% in live pups at the high dose by means of gavage of AEEA, but without lethality compared with intraperitoneal injection. A grading system for the dose-response of DAA lesions associated with AEEA by gavage was established. Gestational day 20 fetuses from treated dams showed a decreased content and altered distribution of medial and adventitial collagen type 1 and 3 in aorta by immunohistochemistry; this decrease was confirmed by native Western blot. CONCLUSION This in vivo model of spontaneous aortic dissection bears striking similarities histologically to human aortic dissection. As such, the model conceivably could contribute to elucidating the mechanisms of DAA formation and to exploring diagnostic and therapeutic strategies. The pathogenesis of AEEA-induced DAA may be related to defects in the normal developmental progression of collagen types 1 and 3 in the vascular wall.
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Affiliation(s)
- Ya Xu
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
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Landman AB, Torbati SS. Chronic Aortic Dissection in a Young Adult. J Emerg Med 2012; 42:e105-8. [DOI: 10.1016/j.jemermed.2009.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 02/05/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
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An 8-year-old boy with bilateral lower extremity pain and weakness. Pediatr Emerg Care 2011; 27:872-3. [PMID: 21926890 DOI: 10.1097/pec.0b013e31822c2896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We illustrate a case of an 8-year-old boy presenting acutely with bilateral lower extremity pain and weakness. This case illustrates the presentation and progression of a rare and potentially lethal diagnosis and highlights the use of computed tomography angiography in the setting of a patient with acute onset of pain and pulselessness of the lower extremities.
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Fikar CR, Fikar R. Aortic dissection in childhood and adolescence: an analysis of occurrences over a 10-year interval in New York State. Clin Cardiol 2010; 32:E23-6. [PMID: 19322890 DOI: 10.1002/clc.20383] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rarely occurring in the pediatric and adolescent population, aortic dissection is a condition with many predisposing factors. Previous studies have suggested that congenital cardiovascular disorders are the most common predisposing conditions. Trauma-associated aortic dissection is considered a rare occurrence. METHODS The Statewide Planning and Research Cooperative System database of New York State was used to retrieve cases of aortic dissection in persons < or = 21 years old over a 10-year period. A retrospective analysis for risk or associated conditions was undertaken. RESULTS Forty-five of a total of 12,142 cases of aortic dissection (0.37%) occurred in persons < or = 21 years old. No patient was younger than 15 years of age. Six of the 45 died (13%). Most patients were male (37 of 45, or 82%). Contrary to previous reports, the most common associated condition was trauma (19 of 45, or 42%), with Marfan syndrome the second most common (11 of 45, or 24%). Ten of 45 adolescent and young adult patients (22%) had no apparent risk factors. CONCLUSIONS Traumatic aortic disruptions must be considered in children and adolescents who survive serious chest trauma. Family members of pediatric and young adult patients with trauma-associated aortic dissection may need to be evaluated for possible risk of aortic dissection.
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Affiliation(s)
- Charles R Fikar
- Caritas Health Care/Mary Immaculate Hospital, Woods Health Sciences Library, Jamaica, New York 11432, USA.
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Goran KP. Aortic dissection in the young: when to suspect? Am J Emerg Med 2009; 27:236-7. [PMID: 19371534 DOI: 10.1016/j.ajem.2008.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 09/23/2008] [Indexed: 10/20/2022] Open
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