Clinical CommunicationsAcute dissecting thoracic aortic aneurysm presenting with stroke, consumptive coagulopathy, and gastrointestinal hemorrhage1
Introduction
Consumption coagulopathy (disseminated intravascular coagulopathy) caused by extensive thrombus formation can occur in uncomplicated arterial aneurysms and in spontaneous aortic dissection 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. Thoracic aortic aneurysms can dissect to involve the carotid vessels and can cause cerebral infarction by perfusion deficits occurring secondary to the dissection and branch vessel occlusion. Thoracic aortic dissections can also progress inferiorly to involve the descending aorta and superior mesenteric artery, leading to infarction of the bowel and subsequent gastrointestinal hemorrhage 11, 12. This report describes an unusual patient who presented to the Emergency Department (ED) with all three complications, leading to a diagnostic challenge.
Section snippets
Case report
A 70-year-old man with past history of bronchial asthma, myocardial infarction, and alcohol abuse was in his usual state of health when his wife found him unconscious in the bathroom. His medical conditions had been controlled with prednisone 5 mg every other day, long-acting theophylline, and metered-dose inhaler albuterol on an “as needed” basis. He had reported no recent complaints to his wife before the acute syncope.
En route to the hospital, the patient experienced emesis, followed by a
Discussion
Aortic dissection was described as early as the middle of the 18th century in a postmortem study and defined as a process by Laennec in 1819 (13). Two factors are felt to be necessary to cause aortic dissection, a predisposing structural weakness of the aortic wall and an initiating event. The area of tear from which the dissection occurs appears to be the intima in most cases, although the media is suspected in about 4% of autopsy findings (14). Common structural weaknesses may occur secondary
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Clinical Communications (Adults) is coordinated by Ron M Walls, MD, of Brigham and Women’s Hospital and Harvard University Medical School, Boston, Massachusetts