An Incidental Finding Of Dissecting Aortic Aneurysm In 63 Year Old Male; Case Report

Abstract

Aortic dissection is one of the acute aortic syndromes and a type of arterial dissection. The term Acute Aortic Syndrome (AAS) is used to describe a spectrum of life-threatening aortic emergencies of the thoracic aorta: classic Aortic Dissection (AD), Intramural Hematoma (IMH) and Penetrating Atherosclerotic Ulcer (PAU). Aortic dissection starts with a tear in the intima of the aortic lining. The tear allows a column of blood under pressure to enter the aortic wall, forming a haematoma. Hemorrhage in the media (at vasa vasorum) leads to either a tear in the weakened intima which breaks into the lumen or hemorrhage separates media from adventitia. The false lumen extends for a variable distance in either direction. The most common sites for the intimal tear are within 2-3 cm of the aortic valve or distal to the left subclavian artery in the descending aorta.

The incidence of aortic dissection is approximately 3-4 per 100,000 per year.  Aortic dissection is the most common emergency affecting the aorta. The incidence is about 3:1 male tofemale predominance. It is most common between the ages of 50-70, being rare below the age of 40. The age of the index case falls within this range (63years). Aortic dissection is very rare in children butit
has been reported in association with coarctation of the aorta. Aortic dissection is a medical emergency and can quickly lead
to death, even with optimal treatment, as a result of decreased blood supply to other organs, heart failure, and sometimes rupture of the aorta. Aortic dissection is more common in those with a history of high blood pressure, a known thoracic aortic aneurysm, and in a number of connective tissue diseases that affect blood vessel wall integrity such as Marfan syndrome and the vascular subtype
of Ehlers-Danlos syndrome. Other risk factors include structural aortic abnormalities such as bicuspid aortic valve, aortic coarctation, Tuer syndrome, pregnancy , intra-aortic balloon pumps , infection(salmonella, typhoid and syphilis), trauma (decelerating injuries), takayasu and giant cell arthrides.
The diagnosis is made with medical imaging (computed tomography, magnetic resonance imaging or echocardiography).
This case is being presented to highlight the essence of prompt request of imaging modality a patient who presents with recurrent chest pain, treated as a chronic case of dyspepsia without due investigations who was eventually seen to suffer from aortic dissection.