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Corvino A, Lonardo V, Tafuri D, Cocco G, Pizzi AD, Boccatonda A, Corvino F, Costantino TG, Horer T, Catalano O. Aortic dissection: How to identify it during an abdominal ultrasound examination and achieve a potentially lifesaving diagnosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38822664 DOI: 10.1002/jcu.23741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/05/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024]
Abstract
Aortic dissection (AD) is a rare and potentially fatal condition that may be diagnosed late. During an emergency or elective abdominal ultrasound (US) examination, when going to evaluate the abdominal aorta for other reasons, it may happen that we find ourselves suspecting an AD. It is therefore important to know the US characteristics of this pathology to avoid wrong or missed diagnoses. Here, we present our practical experience regarding the application of US in the study of the abdominal aorta, which allowed us on several occasions to find an unexpected dissection in patients brought to our attention for other reasons.
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Affiliation(s)
- Antonio Corvino
- Medical, Movement and Wellbeing Sciences Department, University of Naples "Parthenope", Naples, Italy
| | - Valeria Lonardo
- Advanced Biomedical Sciences Department, University of Naples Federico II, Naples, Italy
| | - Domenico Tafuri
- Medical, Movement and Wellbeing Sciences Department, University of Naples "Parthenope", Naples, Italy
| | - Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Innovative Technologies in Medicine and Dentistry, University "G. d'Annunzio", Chieti, Italy
| | - Andrea Boccatonda
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Thomas G Costantino
- Division of Emergency Ultrasound, Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Tal Horer
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
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2
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Yasrab M, Rizk RC, Chu LC, Fishman EK. Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem. Emerg Radiol 2024; 31:269-276. [PMID: 38236521 DOI: 10.1007/s10140-024-02204-6] [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: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
Non-traumatic thoracic aorta emergencies are acute conditions associated with substantial morbidity and mortality. In the emergency setting, timely detection of aortic injury through radiological imaging is crucial for prompt treatment planning and favorable patient outcomes. 3D cinematic rendering (CR), a novel rendering algorithm for computed tomography (CT) image processing, allows for life-like visualization of spatial details and contours of highly complex anatomic structures such as the thoracic aorta and its vessels, generating a photorealistic view that not just adds to diagnostic confidence, but is especially useful for non-radiologists, including surgeons and emergency medicine physicians. In this pictorial review, we demonstrate the utility of CR in the setting of non-traumatic thoracic aorta emergencies through 10 cases that were processed at a standalone 3D CR station at the time of presentation, including its role in diagnosis and management.
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Affiliation(s)
- Mohammad Yasrab
- Department of Radiology, School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287-0801, USA.
| | - Ryan C Rizk
- Department of Radiology, School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287-0801, USA
| | - Linda C Chu
- Department of Radiology, School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287-0801, USA
| | - Elliot K Fishman
- Department of Radiology, School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287-0801, USA
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3
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Kitamura T, Fukuzumi M, Mishima T, Shikata F, Motoji Y, Tamura Y, Horikoshi R, Yokozuka H, Ishiwaki D, Miyaji K. Watch-and-wait strategy for selected patients with type A intramural hematoma. Gen Thorac Cardiovasc Surg 2024; 72:225-231. [PMID: 37592167 DOI: 10.1007/s11748-023-01967-y] [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: 05/16/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This single-center retrospective study evaluated early and midterm outcomes of 100 consecutive patients with type A intramural hematoma. METHODS Initial watch-and-wait strategy was indicated if the maximum aortic diameter was < 50 mm, pain score was < 3/10 on the numerical rating scale, and no ulcer-like projection was observed in the ascending aorta. The primary endpoints of this study were all-cause and aorta-related deaths, and the secondary endpoint was aortic events. RESULTS Initial watch-and-wait strategy was indicated in 52 patients. Emergency aortic repair was indicated in the remaining 48 patients; 2, 31, and 15 patients died before surgery, underwent emergency surgery, and declined emergency surgery, respectively. Among the watch-and-wait group, 11 (21%) patients underwent aortic repair during hospitalization. In-hospital mortality rates, 5-year survival rates, and 5-year freedom from aorta-related death were not significantly different between the initial watch-and-wait strategy and emergency surgery (2% vs. 6%, 92% vs. 82%, and 100% vs. 94%, respectively). In the initial watch-and-wait strategy group, 5-year freedom from aortic events and freedom from aortic events involving the ascending aorta were 60% and 66%, respectively. CONCLUSIONS The early and midterm outcomes with the initial watch-and-wait strategy in patients with type A intramural hematoma with a maximum aortic diameter of ≤ 50 mm, pain score of ≤ 3/10, and no ulcer-like projection in the ascending aorta were favorable with no aorta-related death.
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Affiliation(s)
- Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Masaomi Fukuzumi
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Toshiaki Mishima
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yusuke Motoji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yoshimi Tamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Rihito Horikoshi
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hikaru Yokozuka
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Daiki Ishiwaki
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
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4
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Valente T, Sica G, Romano F, Rea G, Lieto R, De Feo M, Della Corte A, Guarino S, Massimo C, Scaglione M, Muto E, Bocchini G. Non-A Non-B Acute Aortic Dissection: Is There Some Confusion in the Radiologist's Mind? Tomography 2023; 9:2247-2260. [PMID: 38133078 PMCID: PMC10746994 DOI: 10.3390/tomography9060174] [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: 08/01/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The aim of this study is to define and determine the rate of acute non-A-non-B aortic dissections, and to evaluate CT angiography findings and possible complications, as well as to discuss management strategies and currently available therapy. Non-A non-B type of aortic dissection is still a grey area in the radiologist's mind, such that it is not entirely clear what should be reported and completed in terms of this disease. METHODS A retrospective single-center study including 36 pre-treatment CT angiograms of consecutive patients (mean age: 61 years) between January 2012 and December 2022 with aortic dissection involving the aortic arch with/without the thoracic descending/abdominal aorta (type non-A non-B). RESULTS According to the dissection anatomy, we identified three modalities of spontaneous acute non-A-non-B anatomical configurations. Configuration 1 (n = 25) with descending-entry tear and retrograde arch extension (DTA entry). Configuration 2 (n = 4) with Arch entry tear and isolated arch involvement (Arch alone). Configuration 3 (n = 7) with Arch entry and anterograde descending (±abdominal) aorta involvement (Arch entry). CT angiogram findings, management, and treatment options are described. CONCLUSIONS Acute non-A non-B dissection represents an infrequent occurrence of aortic arch dissection (with or without involvement of the descending aorta) that does not extend to the ascending aorta. The complete understanding of its natural progression, distinct CT angiography subtypes, optimal management, and treatment strategies remains incomplete. Within our series, patients frequently exhibit a complex clinical course, often necessitating a more assertive approach to treatment compared to type B dissections.
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Affiliation(s)
- Tullio Valente
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Giacomo Sica
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Federica Romano
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Gaetano Rea
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Roberta Lieto
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Marisa De Feo
- Department of Translational Medical Sciences, Vanvitelli University, Monaldi Hospital, 80131 Naples, Italy
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, Vanvitelli University, Monaldi Hospital, 80131 Naples, Italy
| | - Salvatore Guarino
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Candida Massimo
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassary, 07100 Sassari, Italy;
| | - Emanuele Muto
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
| | - Giorgio Bocchini
- General Radiology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (S.G.); (G.B.)
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5
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Caruso M, Rinaldo C, Iacobellis F, Dell'Aversano Orabona G, Grimaldi D, Di Serafino M, Schillirò ML, Verde F, Sabatino V, Camillo C, Ponticiello G, Romano L. Abdominal compartment syndrome: what radiologist needs to know. LA RADIOLOGIA MEDICA 2023; 128:1447-1459. [PMID: 37747669 DOI: 10.1007/s11547-023-01724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
The intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) are life-threatening conditions with a significant rate of mortality; therefore, early detection is paramount in their optimal management. IAH is diagnosed when the intra-abdominal pressure (IAP) is more than 12 mmHg. It can occur when the intra-abdominal volume increases (ileus, ascites, trauma, pancreatitis, etc.) and/or the abdominal wall compliance decreases. IAH can cause decreased venous flow, low cardiac output, renal impairment, and decreased respiratory compliance. Consequently, these complications can lead to multiple organ failure and induce the abdominal compartment syndrome (ACS) when IAP rises above 20 mmHg. The diagnosis is usually made with intravesical pressure measurement. However, this measurement was not always possible to obtain; therefore, alternative diagnostic techniques should be considered. In this setting, computed tomography (CT) may play a crucial role, allowing the detection and characterization of pathological conditions that may lead to IAH. This review is focused on the pathogenesis, clinical features, and radiological findings of ACS, because their presence allows radiologists to raise the suspicion of IAH/ACS in critically ill patients, guiding the most appropriate treatment.
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Affiliation(s)
- Martina Caruso
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy.
| | - Chiara Rinaldo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | | | - Dario Grimaldi
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Maria Laura Schillirò
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesco Verde
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Vittorio Sabatino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Costanza Camillo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Gianluca Ponticiello
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
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6
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Valente T, Bocchini G, Massimo C, Rea G, Lieto R, Guarino S, Muto E, Abu-Omar A, Scaglione M, Sica G. Multidetector CT Imaging Biomarkers as Predictors of Prognosis in Shock: Updates and Future Directions. Diagnostics (Basel) 2023; 13:2304. [PMID: 37443697 PMCID: PMC10341185 DOI: 10.3390/diagnostics13132304] [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: 05/15/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
A severe mismatch between the supply and demand of oxygen is the common sequela of all types of shock, which present a mortality of up to 80%. Various organs play a protective role in shock and contribute to whole-body homeostasis. The ever-increasing number of multidetector CT examinations in severely ill and sometimes unstable patients leads to more frequently encountered findings leading to imminent death, together called "hypovolemic shock complex". Features on CT include dense opacification of the right heart and major systemic veins, venous layering of contrast material and blood, densely opacified parenchyma in the right hepatic lobe, decreased enhancement of the abdominal organ, a dense pulmonary artery, contrast pooling in dependent lungs, and contrast stasis in pulmonary veins. These findings are biomarkers and prognostic indicators of paramount importance which stratify risk and improve patient outcomes. In this review, we illustrate the various CT patterns in shock and review the spectrum and prognostic significance of thoraco-abdominal vascular and visceral alarming signs of impending death with the intention of increasing awareness among radiologists and radiographers to prepare for immediate resuscitation when required.
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Affiliation(s)
- Tullio Valente
- Department of Radiology, Monaldi Hospital, Azienda dei Colli, 80131 Naples, Italy (G.S.)
| | - Giorgio Bocchini
- Department of Radiology, Monaldi Hospital, Azienda dei Colli, 80131 Naples, Italy (G.S.)
| | - Candida Massimo
- Department of Radiology, Monaldi Hospital, Azienda dei Colli, 80131 Naples, Italy (G.S.)
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, Azienda dei Colli, 80131 Naples, Italy (G.S.)
| | - Roberta Lieto
- Department of Radiology, Monaldi Hospital, Azienda dei Colli, 80131 Naples, Italy (G.S.)
| | - Salvatore Guarino
- Department of Radiology, Monaldi Hospital, Azienda dei Colli, 80131 Naples, Italy (G.S.)
| | - Emanuele Muto
- Department of Radiology, Monaldi Hospital, Azienda dei Colli, 80131 Naples, Italy (G.S.)
| | - Ahmad Abu-Omar
- Department of Radiology, Vancouver General Hospital, 899 W 12th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Mariano Scaglione
- Department of Radiology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda dei Colli, 80131 Naples, Italy (G.S.)
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Scaglione M, Masala S, Iacobellis F, Tonerini M, Sica G, Liguori C, Saba L, Tamburrini S. Imaging in Non-Traumatic Emergencies. Tomography 2023; 9:1133-1136. [PMID: 37368545 DOI: 10.3390/tomography9030093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
"Emergency" is a scenario that every medical professional must face since the first day of her/his career [...].
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Affiliation(s)
- Mariano Scaglione
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy
- Department of Radiology, James Cook University Hospital & Teesside University, Marton Road Marton Rd., Middlesbrough TS4 3BW, UK
| | - Salvatore Masala
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Via Cardarelli 9, 80100 Napoli, Italy
| | - Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Via Cisanello, 56124 Pisa, Italy
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, 80131 Naples, Italy
| | - Carlo Liguori
- Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo, 11, 80147 Napoli, Italy
| | - Luca Saba
- Department of Medical Sciences, University of Cagliari, 09124 Cagliari, Italy
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Pierro A, Posa A, Iorio L, Tanzilli A, Cucciolillo L, Quinto F, Sciandra M, Iezzi R, Cilla S. Bib Sign in Proximal Descending Thoracic Aorta Rupture on CT Angiography: Presentation of a Paradigmatic Case. Case Rep Radiol 2022; 2022:6947207. [PMID: 36518096 PMCID: PMC9744601 DOI: 10.1155/2022/6947207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 08/30/2023] Open
Abstract
Thoracic aortic rupture may present with subtle clinical and CT-angiography findings. Recognition of the imaging features of early rupture is key for timely diagnosis and treatment. This report presents a new sign of incipient proximal thoracic aortic rupture on CT-angiography.
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Affiliation(s)
- Antonio Pierro
- Radiology Department, Cardarelli Regional Hospital, Viale Luigi Montalbò, 86100 Campobasso, Italy
| | - Alessandro Posa
- Vascular Surgery and Endovascular Unit, Cardarelli Regional Hospital, Viale Luigi Montalbò, 86100 Campobasso, Italy
| | - Luca Iorio
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, “A. Gemelli” University Hospital, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Alessandro Tanzilli
- Vascular Surgery and Endovascular Unit, Cardarelli Regional Hospital, Viale Luigi Montalbò, 86100 Campobasso, Italy
| | - Lucia Cucciolillo
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, “A. Gemelli” University Hospital, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Fabio Quinto
- Ospedale L. Bonomo, Viale Istria, 76123 Andria, Italy
| | - Mariacarmela Sciandra
- Radiology Department, Cardarelli Regional Hospital, Viale Luigi Montalbò, 86100 Campobasso, Italy
| | - Roberto Iezzi
- Vascular Surgery and Endovascular Unit, Cardarelli Regional Hospital, Viale Luigi Montalbò, 86100 Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, L.go A. Gemelli, 1, 86100 Campobasso, Italy
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9
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Rahman M, Song A, Greenstein J, Hahn B. A Penetrating Issue. J Emerg Med 2022; 63:681-682. [PMID: 36369116 DOI: 10.1016/j.jemermed.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/19/2022] [Accepted: 09/04/2022] [Indexed: 11/11/2022]
Affiliation(s)
| | - Alexander Song
- Department of Radiology, Staten Island University Hospital, Staten Island, New York
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Right Heart Failure as an Atypical Presentation of Chronic Type A Aortic Dissection - Multimodality Imaging for Accurate Diagnosis and Treatment. A case report and mini-review of literature. J Crit Care Med (Targu Mures) 2022; 8:204-213. [PMID: 36062037 PMCID: PMC9396954 DOI: 10.2478/jccm-2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background An intrapericardial organized haematoma secondary to chronic type A aortic dissection is an extremely rare cause of right heart failure. Imaging studies are essential in recognising and diagnosis of this distinctive medical condition and guiding the anticipated treatment. Case presentation A 70-year-old male patient was admitted for progressive symptoms of right heart failure. His cardiovascular history exposed an aortic valve replacement 22 years before with a Medtronic Hall 23 tilting valve with no regular follow-up. Classical signs of congestion were recognized at physical examination. Transthoracic two-dimensional echocardiography and thoraco-abdominal computed tomography angiography, as essential parts of multimodality imaging algorithm, established the underlying cause of right heart failure. Under total cardiopulmonary bypass and cardiac arrest, surgical removal of the haematoma and proximal repair of the ascending aorta with a patient-matched vascular graft were successfully performed. The patient was discharged in good condition with appropriate pharmacological treatment, guideline-directed; no imagistic signs of acute post-surgery complications were ascertained. Conclusion This paper highlights the importance of recognizing and providing a timely clinical and imagistic diagnosis of this very rare, potentially avoidable cause of right heart failure in patients with previous cardiac surgery.
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