Cold Legs, Chest Pain
Case History:: 69-year-old patient with pain in legs and feeling of cold legs and chest pain.
Case History: 69-year-old patient presents with complaints of pain in legs and feeling of cold legs and chest pain.
69-year-old patient presents with complaints of pain in legs and feeling of cold legs and chest pain.
Figure 1. GRE images show intimal flap and double lumen.
Figure 2A. Involvement of ascending aorta and arch of aorta and descending aorta.
Figure 2B. Involvement of ascending aorta and arch of aorta and descending aorta.
Figure 3. Hematoma around aorta.
Figure 4. Dissection in descending aorta.
Figure 5A. Thrombus in one lumen extending to left iliac artery.
Figure 5B. Thrombus in one lumen extending to left iliac artery.
Figure 6. Coronal image showing dissection.
As both ascending and descending aorta were involved, DeBakey type A dissection was diagnosed.
Imaging is essential in delineating the morphology and extent of the dissection as well as allowing for classification (which dictates management).Â
CT, especially with arterial contrast enhancement (CTA), is the investigation of choice.
An essential part of the assessment of aortic dissection is identifying the true lumen, as placement of an endoluminal stent graft in the false lumen can have dire consequences.
Chronic dissection flaps are often thicker and straighter than those seen in acute dissections.
Although in general MRA has been reserved for follow-up examinations, rapid non-contrast imaging techniques (eg, true FISP) may see MRI having a larger role to play in the acute diagnosis.
Conventional digital subtraction angiography has historically been the gold standard investigation.
Aortic dissection is one of the acute aortic syndromes and a type of arterial dissection.
The majority of aortic dissections are seen in elderly hypertensive patients.
Patients are often hypertensive (although they may be normotensive or hypotensive) and present with anterior or posterior chest pain and a tearing sensation in the chest.Â
In some cases of aortic rupture, the involvement of coronary arteries may result in collapse and death.
The normal lumen lined by intima is called the true lumen and the blood-filled channel in the media is called the false lumen.
Treatment includes aggressive blood pressure control with beta blockers.
A type A dissection may also result in coronary artery occlusion, aortic incompetence, rupture into pericardial sac with resulting cardiac tamponade.
