A Case of Acute Type B Aortic Dissection Subsequent to Asymptomatic Chronic Type A Aortic Dissection Which Was Difficult to Distinguish from Acute Type A Aortic Dissection

Hitoshi Suzuki; Yasuhiro Sawada; Kentaro Inoue; Masaki Yada; Uhito Yuasa; Chiaki Kondo; Hideto Shimpo

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A Case of Acute Type B Aortic Dissection Subsequent to Asymptomatic Chronic Type A Aortic Dissection Which Was Difficult to Distinguish from Acute Type A Aortic Dissection

VernacularTitle:術前診断に苦慮した慢性 Stanford A 型大動脈解離に急性 Stanford B 型大動脈解離が重複した1例
Author: Hitoshi SUZUKI ¹ ; Yasuhiro SAWADA ¹ ; Kentaro INOUE ² ; Masaki YADA ³ ; Uhito YUASA ³ ; Chiaki KONDO ¹ ; Hideto SHIMPO ¹
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1. Department of Cardiovascular Surgery, Mie Prefectural General Medical Center
2. Department of Cardiovascular Surgery, Matsusaka Chuo General Hospital
3. Department of Cardiovascular Surgery, Kuwana City Medical Center
Keywords: chronic type A dissection; acute type B dissection; coexisting; asymptomatic aortic dissection
From:Japanese Journal of Cardiovascular Surgery 2020;49(2):77-80
CountryJapan
Language:Japanese
Abstract: Aortic dissection presents with acute chest or back pain. However, it can be asymptomatic in the acute phase with delayed symptomatic presentation or incidental diagnosis upon chest imaging. We report a case of acute type B aortic dissection subsequent to chronic type A aortic dissection which was difficult to distinguish from acute type A aortic dissection. A 45-year-old man was admitted to a hospital with sudden back pain. An enhanced chest CT revealed a suspected acute type A aortic dissection. The patient was transferred to our hospital and we performed an emergent total arch replacement. Intraoperative findings showed that there were two entries at the origin of the brachiocephalic artery and the left subclavian artery. The ascending aorta presented wall thickening but the descending aorta did not present wall thickening. Histopathologically, the adventitia was obviously thickened with dissection findings in the tunica media. Thus it was diagnosed as acute type B aortic dissection subsequent to chronic type A aortic dissection. Great caution should be taken in asymptomatic chronic aortic dissection.