Case Report
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AKUT PULMONER EMBOLİ İLE TİP B AORT DİSEKSİYONUNUN NADİR BİRLİKTELİĞİ

Year 2020, Volume: 3 Issue: 3, 92 - 95, 30.09.2020

Abstract

Amaç: Pulmoner emboli ve aort diseksiyonu belirti ve bulguları birbirine benzer, ve her iki durumda da mortalite yüksektir. Birlikte tanısı nadirdir ve tanı alması durumunda tedavi açısından ikilem yaratır. Her iki tanıda da bilgisayarlı tomografi en çok kullanılan görüntüleme yöntemidir, acil hekimleri için yatak başı ultrason görüntülemesi de tanıda oldukça faydalıdır. Olgumuz pulmoner emboli ve aort diseksiyonu birlikteliği olan 87 yaşında erkek hastadır.

Olgu Sunumu: Seksen yedi yaşında erkek hasta konuşma bozukluğu ve bilinç durum değişikliği ile acil servisimize başvurdu. Hipertansiyon, koroner arter hastalığı ve diabetes mellitus özgeçmişi mevcut idi. Hastanın ilk başvuru vital ölçümleri hipotansif ve taşikardik idi. Akciğer grafisinde aort topuzunda belirginleşme ve özefagus ve trakeasında sağa deviyasyon mevcut idi. Yatak başı ultrason görüntülemesinde her iki alt femoral venlerde komprese edilemeyen trombus ile uyumlu görünüm ve EKO’ da kalbin sağ boşlularında dilatasyon ve aort çıkımında genişleme görüldü. Çekilen bilgisayarlı tomografi anjiosunda aort çıışında anevrizmatik dilatasyon ve inen aortada diseskiyon yanı sıra sol ana pulmoner arter ve segmenter dallarda trombus saptandı.

Sonuç: Acil servise başvuran hastalarda farklı tanıların bir arada görülebileceği akılda tutulmalı ve hastada kliniği açıklayan bir tanı konulsa bile altta yatan ikinci bir tanının varlığı göz ardı edilmemelidir.

Supporting Institution

Yok

Project Number

-

References

  • Rare association of acute pulmonary embolism and type B aortic dissection: anticoagulant therapeutic dilemma | [Internet]. [cited 2020 Sep 21]. Available from: https://www.romanianjournalcardiology.ro/arhiva/rare-association-of-acute-pulmonary-embolism-and-type-b-aortic-dissection-anticoagulant-therapeutic-dilemma/
  • Mussa FF, Horton JD, Moridzadeh R ark. Acute Aortic Dissection and Intramural Hematoma: A Systematic Review. JAMA. 2016 Aug 16;316(7):754–63.
  • Bickerstaff LK, Pairolero PC, Hollier LH ark. Thoracic aortic aneurysms: a population-based study. Surgery. 1982 Dec;92(6):1103–8.
  • Sardi A, Gluskin J, Guttentag A ark. Saddle pulmonary embolism: is it as bad as it looks? A community hospital experience. Crit Care Med. 2011 Nov;39(11):2413–8.
  • Pathophysiology, diagnosis, and management of aortic dissection - Pawan D. Patel, Rohit R. Arora, 2008 [Internet]. [cited 2020 Sep 21]. Available from: https://journals.sagepub.com/doi/abs/10.1177/1753944708090830
  • Moore AG, Eagle KA, Bruckman D ark. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). American Journal of Cardiology. 2002 May 15;89(10):1235–8.
  • Halpern EJ. Triple-Rule-Out CT Angiography for Evaluation of Acute Chest Pain and Possible Acute Coronary Syndrome. Radiology. 2009 Aug 1;252(2):332–45.
  • Neri E, Toscano T, Civeli L ark. Acute Dissecting Aneurysm of the Ascending Thoracic Aorta Causing Obstruction and Thrombosis of the Right Pulmonary Artery. Tex Heart Inst J. 2001;28(2):149–51.
  • Nasrallah A, Goussous Y, El-Said G ark. Pulmonary artery compression due to acute dissecting aortic aneurysm: clinical and angiographic diagnosis. Chest. 1975 Feb;67(2):228–30.
  • Al-Zuabi. A rare case of leaking thoracic aortic aneurysm in a patient with massive pulmonary embolism [Internet]. [cited 2020 Sep 21]. Available from: http://www.esim.eg.net/article.asp?issn=1110-7782;year=2013;volume=25;issue=1;spage=47;epage=50;aulast=Al-Zuabi#ft1
  • Zhe Chai D, Zhang HY. Pulmonary Embolism and Stanford Type B Aortic Dissection in the Same Patient. J Vasc Med Surg [Internet]. 2015 [cited 2020 Sep 21];03(06). Available from: http://www.esciencecentral.org/journals/pulmonary-embolism-and-stanford-type-b-aortic-dissection-in-the-same-patient-2329-6925-1000226.php?aid=64413
  • Konstantinides SV, Meyer G, Becattini C ark. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 21;41(4):543–603.
  • Kim DH, Ryu SW, Choi YS ark. Aortic Dissection Presenting with Secondary Pulmonary Hypertension Caused by Compression of the Pulmonary Artery by Dissecting Hematoma: A Case Report. Korean J Radiol. 2004;5(2):139–42.
  • Bocchino PP, De Filippo O, Piroli F ark. Anticoagulant and anti-thrombotic therapy in acute type B aortic dissection: when real-life scenarios face the shadows of the evidence-based medicine. BMC Cardiovascular Disorders. 2020 Jan 23;20(1):29.

Rare Coexistence of Acute Pulmonary Embolism and Type B Aortic Dissection

Year 2020, Volume: 3 Issue: 3, 92 - 95, 30.09.2020

Abstract

Aim: Signs and symptoms of pulmonary embolism and aortic dissection are similar, and mortality is high in both cases. Co-diagnosis is rare and, if diagnosed, creates a treatment dilemma. Computed tomography is the most used imaging method in both diagnoses, and bedside ultrasound imaging is also very useful for emergency physicians. Our case is an 87-year-old male patient with pulmonary embolism and aortic dissection.

Case Report: An 87-year-old male patient was admitted to our emergency department with speech impairment and ab altered state of consciousness. The patient had a history of hypertension, coronary artery disease, and diabetes mellitus. The patient's initial vital measurements were hypotensive and tachycardic. Chest radiography showed prominence in the aorta and deviation to the right in the esophagus and trachea. Appearance compatible with uncompressible thrombus in both lower femoral veins on bedside ultrasound imaging and ECHO showed dilatation in the right chambers of the heart and enlargement in the aortic outlet. Computed tomography angiography revealed aneurysmatic dilatation at the outlet of the aorta and dissection in the descending aorta, as well as a thrombus in the left main pulmonary artery and segmental branches.

Conclusion: It should be kept in mind that different diagnoses can be seen together in patients admitted to the emergency department. Even if a diagnosis explaining the clinic is made in the patient, the presence of a second underlying diagnosis should not be ignored.

Project Number

-

References

  • Rare association of acute pulmonary embolism and type B aortic dissection: anticoagulant therapeutic dilemma | [Internet]. [cited 2020 Sep 21]. Available from: https://www.romanianjournalcardiology.ro/arhiva/rare-association-of-acute-pulmonary-embolism-and-type-b-aortic-dissection-anticoagulant-therapeutic-dilemma/
  • Mussa FF, Horton JD, Moridzadeh R ark. Acute Aortic Dissection and Intramural Hematoma: A Systematic Review. JAMA. 2016 Aug 16;316(7):754–63.
  • Bickerstaff LK, Pairolero PC, Hollier LH ark. Thoracic aortic aneurysms: a population-based study. Surgery. 1982 Dec;92(6):1103–8.
  • Sardi A, Gluskin J, Guttentag A ark. Saddle pulmonary embolism: is it as bad as it looks? A community hospital experience. Crit Care Med. 2011 Nov;39(11):2413–8.
  • Pathophysiology, diagnosis, and management of aortic dissection - Pawan D. Patel, Rohit R. Arora, 2008 [Internet]. [cited 2020 Sep 21]. Available from: https://journals.sagepub.com/doi/abs/10.1177/1753944708090830
  • Moore AG, Eagle KA, Bruckman D ark. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). American Journal of Cardiology. 2002 May 15;89(10):1235–8.
  • Halpern EJ. Triple-Rule-Out CT Angiography for Evaluation of Acute Chest Pain and Possible Acute Coronary Syndrome. Radiology. 2009 Aug 1;252(2):332–45.
  • Neri E, Toscano T, Civeli L ark. Acute Dissecting Aneurysm of the Ascending Thoracic Aorta Causing Obstruction and Thrombosis of the Right Pulmonary Artery. Tex Heart Inst J. 2001;28(2):149–51.
  • Nasrallah A, Goussous Y, El-Said G ark. Pulmonary artery compression due to acute dissecting aortic aneurysm: clinical and angiographic diagnosis. Chest. 1975 Feb;67(2):228–30.
  • Al-Zuabi. A rare case of leaking thoracic aortic aneurysm in a patient with massive pulmonary embolism [Internet]. [cited 2020 Sep 21]. Available from: http://www.esim.eg.net/article.asp?issn=1110-7782;year=2013;volume=25;issue=1;spage=47;epage=50;aulast=Al-Zuabi#ft1
  • Zhe Chai D, Zhang HY. Pulmonary Embolism and Stanford Type B Aortic Dissection in the Same Patient. J Vasc Med Surg [Internet]. 2015 [cited 2020 Sep 21];03(06). Available from: http://www.esciencecentral.org/journals/pulmonary-embolism-and-stanford-type-b-aortic-dissection-in-the-same-patient-2329-6925-1000226.php?aid=64413
  • Konstantinides SV, Meyer G, Becattini C ark. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 21;41(4):543–603.
  • Kim DH, Ryu SW, Choi YS ark. Aortic Dissection Presenting with Secondary Pulmonary Hypertension Caused by Compression of the Pulmonary Artery by Dissecting Hematoma: A Case Report. Korean J Radiol. 2004;5(2):139–42.
  • Bocchino PP, De Filippo O, Piroli F ark. Anticoagulant and anti-thrombotic therapy in acute type B aortic dissection: when real-life scenarios face the shadows of the evidence-based medicine. BMC Cardiovascular Disorders. 2020 Jan 23;20(1):29.
There are 14 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Case Report
Authors

Engin Özakın 0000-0003-4301-5440

Sevinç Erdem This is me 0000-0001-5646-2982

Project Number -
Publication Date September 30, 2020
Published in Issue Year 2020 Volume: 3 Issue: 3

Cite

AMA Özakın E, Erdem S. AKUT PULMONER EMBOLİ İLE TİP B AORT DİSEKSİYONUNUN NADİR BİRLİKTELİĞİ. Anatolian J Emerg Med. September 2020;3(3):92-95.