Leaking giant aneurysm of the aortic root due to cystic medial necrosis with pericardial tamponade mimicking type-A aortic dissection

Details

Serval ID
serval:BIB_C851D8A7540E
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Leaking giant aneurysm of the aortic root due to cystic medial necrosis with pericardial tamponade mimicking type-A aortic dissection
Journal
Thoracic and Cardiovascular Surgeon
Author(s)
Attenhofer  C. H., Vogt  P. R., von Segesser  L. K., Dirsch  O. R., Ritter  M., Jenni  R.
ISSN
0171-6425
Publication state
Published
Issued date
04/1996
Peer-reviewed
Oui
Volume
44
Number
2
Pages
103-4
Notes
Case Reports
Journal Article --- Old month value: Apr
Abstract
The diagnosis of acute type-A aortic dissection is predominantly based on the demonstration of an intimal tear or a dissection membrane. We describe another pathogenetic mechanism in a patient with the typical features of acute aortic dissection with pericardial tamponade, and a giant aneurysm of the ascending aorta. However, no dissection membrane, rupture site, or intimal tear could be demonstrated by transesophageal echocardiography, intraoperatively, or histologically. The histological work-up showed an extreme form of cystic medial necrosis with intramural hemorrhages consistent with a leaking aneurysm. Hence, in a patient with a symptomatic aneurysm of the aortic root and pericardial tamponade, obvious intimal dissection or rupture does not always have to be present echocardiographically or intraoperatively. A different presentation can occur in the setting of an extreme medial necrosis, where blood leaks through the aortic wall causing intramural hemorrhages with intimal leaks invisible to the surgeon's or echocardiographer's eye. This process is clinically indistinguishable from type-A aortic dissection.
Keywords
Aneurysm, Dissecting/classification/diagnosis/*etiology Aorta/*pathology Aortic Aneurysm/diagnosis/*etiology/surgery Cardiac Tamponade/*etiology Causality Diagnosis, Differential Humans Male Middle Aged Necrosis Tunica Media/*pathology
Pubmed
Web of science
Create date
14/02/2008 14:16
Last modification date
20/08/2019 15:43
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