American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2015, 3(10), 338-343
DOI: 10.12691/ajmcr-3-10-9
Open AccessCase Report

Aortic Dissection with Hemopericardium and Thrombosed Left Common Iliac Artery Presenting as Acute Limb Ischemia: A Case Report and Review

Vinod Namana1, , Ram Balasubramanian1, Pramod Theetha Kariyanna2, Rajeswer Sarasam1, Sruthi Namana1 and Vijay Shetty1

1Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA

2Department of Internal Medicine, Downstate Medical center, Brooklyn, NY, USA

Pub. Date: September 16, 2015

Cite this paper:
Vinod Namana, Ram Balasubramanian, Pramod Theetha Kariyanna, Rajeswer Sarasam, Sruthi Namana and Vijay Shetty. Aortic Dissection with Hemopericardium and Thrombosed Left Common Iliac Artery Presenting as Acute Limb Ischemia: A Case Report and Review. American Journal of Medical Case Reports. 2015; 3(10):338-343. doi: 10.12691/ajmcr-3-10-9

Abstract

Aim: An aortic dissection is an uncommon serious condition, which usually presents with chest pain or upper back pain. Symptoms of aortic dissection may mimic those of other diseases, often leading to delay in diagnosis. Methods: We report an unusual case of aortic dissection with hemopericardium and thrombosed left common iliac artery presenting as acute limb ischemia. Conclusion: Maintaining a high index of clinical suspicion for aortic pathology could possibly lead to identification and timely management of a greater number of patients who have atypical presentations. This would be especially true for patients who have catastrophic presentations with unexplained symptoms.

Keywords:
aortic dissection type a dissection type b dissection hemopericardium cardiogenic shock limb ischemia arterial thrombosis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Figures

Figure of 4

References:

[1]  P. C. Spittell, J. A. Spittell, Jr., J. W. Joyce, A. J. Tajik, W. D. Edwards, H. V. Schaff, et al., “Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990),” Mayo Clin Proc, vol. 68, pp. 642-51, Jul 1993.
 
[2]  C. A. Nienaber and K. A. Eagle, “Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies,” Circulation, vol. 108, pp. 628-35, Aug 5 2003.
 
[3]  Y. von Kodolitsch, A. G. Schwartz, and C. A. Nienaber, “Clinical prediction of acute aortic dissection,” Arch Intern Med, vol. 160, pp. 2977-82, Oct 23 2000.
 
[4]  I. A. De Leon Ayala and Y. F. Chen, “Acute aortic dissection: an update,” Kaohsiung J Med Sci, vol. 28, pp. 299-305, Jun 2012.
 
[5]  I. A. Khan and C. K. Nair, “Clinical, diagnostic, and management perspectives of aortic dissection,” Chest, vol. 122, pp. 311-28, Jul 2002.
 
[6]  S. M. Huang, F. Du, C. Y. Wang, M. J. Bair, and K. T. Wang, “Aortic dissection presenting as isolated lower extremity pain in a young man,” Am J Emerg Med, vol. 28, pp. 1061 e1-3, Nov 2010.
 
[7]  D. Barbic and W. Grad, “Aortic dissection presenting as left leg numbness and paralysis,” Am J Emerg Med, vol. 28, pp. 1063 e7-8, Nov 2010.
 
[8]  G. Avegliano, A. Evangelista, C. Elorz, T. Gonzalez-Alujas, H. Garcia del Castillo, and J. Soler-Soler, “Acute peripheral arterial ischemia and suspected aortic dissection: usefulness of transesophageal echocardiography in differential diagnosis with aortic thrombosis,” Am J Cardiol, vol. 90, pp. 674-7, Sep 15 2002.
 
[9]  N. Raby, J. Giles, and H. Walters, “Aortic dissection presenting as acute leg ischaemia,” Clinical Radiology, vol. 42, pp. 116-117, August 1990 1990.
 
[10]  C. Olsson, S. Thelin, E. Stahle, A. Ekbom, and F. Granath, “Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002,” Circulation, vol. 114, pp. 2611-8, Dec 12 2006.
 
[11]  J. Z. Goldfinger, J. L. Halperin, M. L. Marin, A. S. Stewart, K. A. Eagle, and V. Fuster, “Thoracic aortic aneurysm and dissection,” J Am Coll Cardiol, vol. 64, pp. 1725-39, Oct 21 2014.
 
[12]  D. P. Howard, A. Banerjee, J. F. Fairhead, J. Perkins, L. E. Silver, P. M. Rothwell, et al., “Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study,” Circulation, vol. 127, pp. 2031-7, May 21 2013.
 
[13]  P. G. Hagan, C. A. Nienaber, E. M. Isselbacher, D. Bruckman, D. J. Karavite, P. L. Russman, et al., “The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease,” JAMA, vol. 283, pp. 897-903, Feb 16 2000.
 
[14]  P. S. Saba, M. Cameli, G. Casalnuovo, M. M. Ciccone, A. Ganau, M. Maiello, et al., “Ventricular-vascular coupling in hypertension: methodological considerations and clinical implications,” J Cardiovasc Med (Hagerstown), vol. 15, pp. 773-87, Nov 2014.
 
[15]  J. A. Elefteriades, I. Hatzaras, M. A. Tranquilli, A. J. Elefteriades, R. Stout, R. K. Shaw, et al., “Weight lifting and rupture of silent aortic aneurysms,” JAMA, vol. 290, p. 2803, Dec 3 2003.
 
[16]  I. Hatzaras, M. Tranquilli, M. Coady, P. M. Barrett, J. Bible, and J. A. Elefteriades, “Weight lifting and aortic dissection: more evidence for a connection,” Cardiology, vol. 107, pp. 103-6, 2007.
 
[17]  R. A. Lange and L. D. Hillis, “Cardiovascular complications of cocaine use,” N Engl J Med, vol. 345, pp. 351-8, Aug 2 2001.
 
[18]  M. J. Eisenberg, S. A. Rice, A. Paraschos, G. R. Caputo, and N. B. Schiller, “The clinical spectrum of patients with aneurysms of the ascending aorta,” Am Heart J, vol. 125, pp. 1380-5, May 1993.
 
[19]  J. AUER, R. Berent, and B. Eber, “Aortic dissection: incidence, natural history and impact of surgery,” Journal of Clinical and Basic Cardiology vol. 3, pp. 151-154, 2000 2003.
 
[20]  B. Litchford, J. E. Okies, S. Sugimura, and A. Starr, “Acute aortic dissection from cross-clamp injury,” J Thorac Cardiovasc Surg, vol. 72, pp. 709-13, Nov 1976.
 
[21]  A. G. Archer, P. L. Choyke, R. K. Zeman, C. E. Green, and M. Zuckerman, “Aortic dissection following coronary artery bypass surgery: diagnosis by CT,” Cardiovasc Intervent Radiol, vol. 9, pp. 142-5, 1986.
 
[22]  J. E. Cigarroa, E. M. Isselbacher, R. W. DeSanctis, and K. A. Eagle, “Diagnostic imaging in the evaluation of suspected aortic dissection. Old standards and new directions,” N Engl J Med, vol. 328, pp. 35-43, Jan 7 1993.
 
[23]  R. Erbel, R. Engberding, W. Daniel, J. Roelandt, C. Visser, and H. Rennollet, “Echocardiography in diagnosis of aortic dissection,” Lancet, vol. 1, pp. 457-61, Mar 4 1989.
 
[24]  A. Keren, C. B. Kim, B. S. Hu, I. Eyngorina, M. E. Billingham, R. S. Mitchell, et al., “Accuracy of biplane and multiplane transesophageal echocardiography in diagnosis of typical acute aortic dissection and intramural hematoma,” J Am Coll Cardiol, vol. 28, pp. 627-36, Sep 1996.
 
[25]  R. S. Ballal, N. C. Nanda, R. Gatewood, B. D'Arcy, T. E. Samdarshi, W. L. Holman, et al., “Usefulness of transesophageal echocardiography in assessment of aortic dissection,” Circulation, vol. 84, pp. 1903-14, Nov 1991.
 
[26]  C. A. Nienaber, Y. von Kodolitsch, V. Nicolas, V. Siglow, A. Piepho, C. Brockhoff, et al., “The diagnosis of thoracic aortic dissection by noninvasive imaging procedures,” N Engl J Med, vol. 328, pp. 1-9, Jan 7 1993.
 
[27]  A. L. Pucillo, A. G. Schechter, R. A. Moggio, R. H. Kay, M. S. Tenner, and M. V. Herman, “Postoperative evaluation of ascending aortic prosthetic conduits by magnetic resonance imaging,” Chest, vol. 97, pp. 106-10, Jan 1990.
 
[28]  H. Eggebrecht, D. Baumgart, U. Herold, J. Piotrowski, J. Barkhausen, R. Wiesemes, et al., “Interventional management of aortic dissection,” Herz, vol. 27, pp. 539-47, Sep 2002.
 
[29]  J. I. Fann, J. A. Smith, D. C. Miller, R. S. Mitchell, K. A. Moore, G. Grunkemeier, et al., “Surgical management of aortic dissection during a 30-year period,” Circulation, vol. 92, pp. II113-21, Nov 1 1995.
 
[30]  J. Laas, M. Heinemann, H. J. Schaefers, W. Daniel, and H. G. Borst, “Management of thoracoabdominal malperfusion in aortic dissection,” Circulation, vol. 84, pp. III20-4, Nov 1991.
 
[31]  H. G. Borst and J. Laas, “Surgical treatment of thoracic aortic aneurysms,” Adv Card Surg, vol. 4, pp. 47-87, 1993.
 
[32]  H. Takayama, C. R. Smith, M. E. Bowdish, and A. S. Stewart, “Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia,” J Thorac Cardiovasc Surg, vol. 137, pp. 1450-3, Jun 2009.
 
[33]  R. Rolph, J. M. Duffy, B. Modarai, R. E. Clough, P. Taylor, and M. Waltham, “Stent graft types for endovascular repair of thoracic aortic aneurysms,” Cochrane Database Syst Rev, vol. 3, p. CD008448, 2013.
 
[34]  R. Fattori, P. Cao, P. De Rango, M. Czerny, A. Evangelista, C. Nienaber, et al., “Interdisciplinary expert consensus document on management of type B aortic dissection,” J Am Coll Cardiol, vol. 61, pp. 1661-78, Apr 23 2013.
 
[35]  R. Fattori, D. Montgomery, L. Lovato, S. Kische, M. Di Eusanio, H. Ince, et al., “Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD),” JACC Cardiovasc Interv, vol. 6, pp. 876-82, Aug 2013.
 
[36]  R. A. White, D. C. Miller, F. J. Criado, M. D. Dake, E. B. Diethrich, R. K. Greenberg, et al., “Report on the results of thoracic endovascular aortic repair for acute, complicated, type B aortic dissection at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee,” J Vasc Surg, vol. 53, pp. 1082-90, Apr 2011.
 
[37]  S. Pansini, P. V. Gagliardotto, E. Pompei, F. Parisi, G. Bardi, E. Castenetto, et al., “Early and late risk factors in surgical treatment of acute type A aortic dissection,” Ann Thorac Surg, vol. 66, pp. 779-84, Sep 1998.
 
[38]  M. E. DeBakey, C. H. McCollum, E. S. Crawford, G. C. Morris, Jr., J. Howell, G. P. Noon, et al., “Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically,” Surgery, vol. 92, pp. 1118-34, Dec 1982.
 
[39]  T. Suzuki, E. M. Isselbacher, C. A. Nienaber, R. E. Pyeritz, K. A. Eagle, T. T. Tsai, et al., “Type-selective benefits of medications in treatment of acute aortic dissection (from the International Registry of Acute Aortic Dissection [IRAD]),” Am J Cardiol, vol. 109, pp. 122-7, Jan 1 2012.
 
[40]  L. F. Hiratzka, G. L. Bakris, J. A. Beckman, R. M. Bersin, V. F. Carr, D. E. Casey, Jr., et al., “2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine,” Circulation, vol. 121, pp. e266-369, Apr 6 2010.
 
[41]  The Society of Thoracic Surgeons Blood Conservation Guideline Task, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel, 2nd, C. K. Haan, et al., “Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline,” Ann Thorac Surg, vol. 83, pp. S27-86, May 2007.
 
[42]  E. H. Kincaid, M. L. Monroe, D. L. Saliba, N. D. Kon, W. G. Byerly, and M. G. Reichert, “Effects of preoperative enoxaparin versus unfractionated heparin on bleeding indices in patients undergoing coronary artery bypass grafting,” Ann Thorac Surg, vol. 76, pp. 124-8; discussion 128, Jul 2003.
 
[43]  B. Medalion, G. Frenkel, P. Patachenko, E. Hauptman, L. Sasson, and A. Schachner, “Preoperative use of enoxaparin is not a risk factor for postoperative bleeding after coronary artery bypass surgery,” J Thorac Cardiovasc Surg, vol. 126, pp. 1875-9, Dec 2003.
 
[44]  G. H. Guyatt, E. A. Akl, M. Crowther, D. D. Gutterman, H. J. Schuunemann, T. American College of Chest Physicians Antithrombotic, et al., “Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines,” Chest, vol. 141, pp. 7S-47S, Feb 2012.
 
[45]  M. M. Ciccone, F. Cortese, F. Corbo, N. E. Corrales, A. K. Al-Momen, A. Silva, et al., “Bemiparin, an effective and safe low molecular weight heparin: a review,” Vascul Pharmacol, vol. 62, pp. 32-7, Jul 2014.