Kharawala AM, Brahmbhatt N, Bhopalwala H, Dewaswala N, Bhopalwala A, Ghumman W, Chait RD. A Rare Presentation of an Acute Type A Aortic Dissection Obscured Due to the Simultaneous Presence of Acute Pancreatitis.
HCA Healthc J Med 2021;
2:329-334. [PMID:
37425128 PMCID:
PMC10324739 DOI:
10.36518/2689-0216.1194]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Introduction
Acute pancreatitis (AP) and acute aortic dissection (AAD) are medical emergencies that must be promptly recognized to avoid the development of life-threatening complications. Both of these diseases can present with chest or epigastric pain which can radiate to the back, thus, early suspicion based on clinical presentation and risk factors is essential. We present the case of a 56-year-old patient initially diagnosed with AP who was later found to have an AAD.
Clinical Findings
A 56-year-old man with a history of alcohol abuse presented with 1 day of diffuse abdominal pain, nausea and vomiting. His lipase was 3,909 U/L and creatinine was 2.19 mg/dL and he was diagnosed with acute alcoholic pancreatitis with acute kidney injury. A non-contrast computed tomography (NCCT) scan of the abdomen showed aortic calcifications. He received 3.8 liters of fluids after which he developed acute respiratory distress requiring intubation. A workup for extracorporeal membrane oxygenation (ECMO) was initiated, given the suspicion of acute respiratory distress syndrome (ARDS) due to pancreatitis. This revealed an AAD with severe aortic regurgitation on transthoracic echocardiography (TTE). CT angiogram showed type A AAD involving the aortic root, ascending aorta, descending aorta, suprarenal and infrarenal abdominal aorta. The celiac axis, superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) were patent.
Outcomes
The patient underwent type A AAD repair with mechanical aortic valve replacement and survived the acute event. His AP resolved and he was discharged home with appropriate follow up.
Conclusion
We hypothesize that if our patient was not assessed for ECMO, the finding of AAD would have been a diagnostic challenge. AP secondary to AAD is rare but a high index of suspicion is required for diagnosis.
Collapse