The authors of the above paper, whilst admirably attempting to
highlight the well recognised presentation of a dissecting aorta with
neurological symptoms, have unfortunately confused two very distinct
diseases with two very different distinct pathologies; those of a ruptured
abdominal aneurysm and a dissecting thoracic aorta.
The abdominal aorta is prone to aneurysmal dilatation, which can
rupture spontaneously causing severe abdominal pain and cardiovascular
collapse. The thoracic aorta is not however prone to this complication,
however is prone, much less commonly, to tear. This leads to blood
tracking between the layers of the aorta. This condition presents with
chest pain radiating to the back and not uncommonly presents with
neurological complications due to the blocking off of the carotid vessels
by blood in the false lumen.
It is not clear from the report, which of the two conditions the
patient had although it seems likely that this was a dissecting aorta.
The authors report a case of a ruptured AAA, but quote references from
dissecting aortas and confuse the two pathologies repeatedly throughout
the discussion.
This mistake should have realised during the review process and an
erratum should be published in order not to further confuse the
prehospital readers between the two conditions.
The authors of the above paper, whilst admirably attempting to highlight the well recognised presentation of a dissecting aorta with neurological symptoms, have unfortunately confused two very distinct diseases with two very different distinct pathologies; those of a ruptured abdominal aneurysm and a dissecting thoracic aorta.
The abdominal aorta is prone to aneurysmal dilatation, which can rupture spontaneously causing severe abdominal pain and cardiovascular collapse. The thoracic aorta is not however prone to this complication, however is prone, much less commonly, to tear. This leads to blood tracking between the layers of the aorta. This condition presents with chest pain radiating to the back and not uncommonly presents with neurological complications due to the blocking off of the carotid vessels by blood in the false lumen.
It is not clear from the report, which of the two conditions the patient had although it seems likely that this was a dissecting aorta. The authors report a case of a ruptured AAA, but quote references from dissecting aortas and confuse the two pathologies repeatedly throughout the discussion.
This mistake should have realised during the review process and an erratum should be published in order not to further confuse the prehospital readers between the two conditions.