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Putative computed tomography scan-negative type A dissection
OBJECTIVES: Computed tomography angiography (CTA) is the imaging modality most frequently used to diagnosis type A aortic dissection for chest pain with a high degree of sensitivity and specificity. False negative and positive errors in diagnosis are infrequent. Despite initial negative imaging stud...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9801335/ https://www.ncbi.nlm.nih.gov/pubmed/36590711 http://dx.doi.org/10.1016/j.xjon.2022.10.005 |
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author | Aziz, Jenna Aziz, Salim |
author_facet | Aziz, Jenna Aziz, Salim |
author_sort | Aziz, Jenna |
collection | PubMed |
description | OBJECTIVES: Computed tomography angiography (CTA) is the imaging modality most frequently used to diagnosis type A aortic dissection for chest pain with a high degree of sensitivity and specificity. False negative and positive errors in diagnosis are infrequent. Despite initial negative imaging studies for dissection, surgeons must consider early operation in patients with recent onset chest pain in the presence of an ascending aortic aneurysm. METHODS: We report 4 cases (2004-2021) of patients with a mean age of 51.25 years (male:female = 3:1) who presented with chest pain. Two had a history of syncope. On computed tomography angiography, all had an ascending aortic aneurysm and no dissection flap. Three had thickening of the ascending aorta and 1 had a chronic type B dissection. On echocardiography, aortic regurgitation was moderate–severe in 2 patients, 2 had a pericardial effusion, and none had a definitive dissection flap. All were operated on because of the surgeon's concern for the association of chest pain and an ascending aortic aneurysm. The Institutional Review Board at George Washington University Committee on Human Research has determined that the research is exempt from review under Department of Health and Human Services regulatory category 4 (#FWA00005945). The project as described in the application may proceed without further oversight by the Office of Human Resources on September 9, 2022. RESULTS: The diagnosis of type A aortic dissection was made at operation (3 on median sternotomy and 1 after aortotomy). All patients did well. One patient who had peripheral cannulation (no malperfusion) and severe coagulopathy developed a compartment syndrome and postoperatively required a below-knee amputation. CONCLUSIONS: Surgeons must maintain a high index of suspicion for aortic dissection when patients present with chest pain and are found to have an ascending aortic aneurysm even in the absence of initial, classic features of dissection on computed tomography angiography. Improvements in imaging techniques and analysis are required. |
format | Online Article Text |
id | pubmed-9801335 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-98013352022-12-31 Putative computed tomography scan-negative type A dissection Aziz, Jenna Aziz, Salim JTCVS Open Adult: Aorta OBJECTIVES: Computed tomography angiography (CTA) is the imaging modality most frequently used to diagnosis type A aortic dissection for chest pain with a high degree of sensitivity and specificity. False negative and positive errors in diagnosis are infrequent. Despite initial negative imaging studies for dissection, surgeons must consider early operation in patients with recent onset chest pain in the presence of an ascending aortic aneurysm. METHODS: We report 4 cases (2004-2021) of patients with a mean age of 51.25 years (male:female = 3:1) who presented with chest pain. Two had a history of syncope. On computed tomography angiography, all had an ascending aortic aneurysm and no dissection flap. Three had thickening of the ascending aorta and 1 had a chronic type B dissection. On echocardiography, aortic regurgitation was moderate–severe in 2 patients, 2 had a pericardial effusion, and none had a definitive dissection flap. All were operated on because of the surgeon's concern for the association of chest pain and an ascending aortic aneurysm. The Institutional Review Board at George Washington University Committee on Human Research has determined that the research is exempt from review under Department of Health and Human Services regulatory category 4 (#FWA00005945). The project as described in the application may proceed without further oversight by the Office of Human Resources on September 9, 2022. RESULTS: The diagnosis of type A aortic dissection was made at operation (3 on median sternotomy and 1 after aortotomy). All patients did well. One patient who had peripheral cannulation (no malperfusion) and severe coagulopathy developed a compartment syndrome and postoperatively required a below-knee amputation. CONCLUSIONS: Surgeons must maintain a high index of suspicion for aortic dissection when patients present with chest pain and are found to have an ascending aortic aneurysm even in the absence of initial, classic features of dissection on computed tomography angiography. Improvements in imaging techniques and analysis are required. Elsevier 2022-10-26 /pmc/articles/PMC9801335/ /pubmed/36590711 http://dx.doi.org/10.1016/j.xjon.2022.10.005 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Adult: Aorta Aziz, Jenna Aziz, Salim Putative computed tomography scan-negative type A dissection |
title | Putative computed tomography scan-negative type A dissection |
title_full | Putative computed tomography scan-negative type A dissection |
title_fullStr | Putative computed tomography scan-negative type A dissection |
title_full_unstemmed | Putative computed tomography scan-negative type A dissection |
title_short | Putative computed tomography scan-negative type A dissection |
title_sort | putative computed tomography scan-negative type a dissection |
topic | Adult: Aorta |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9801335/ https://www.ncbi.nlm.nih.gov/pubmed/36590711 http://dx.doi.org/10.1016/j.xjon.2022.10.005 |
work_keys_str_mv | AT azizjenna putativecomputedtomographyscannegativetypeadissection AT azizsalim putativecomputedtomographyscannegativetypeadissection |