A 72-year-old man presented with chief complaints of back pain. Medical workup discovered infrarenal abdominal aortic aneurysm (AAA) with Stanford type B acute aortic dissection on CT. The dissection originated distal to the left subclavian artery and extended to the right commom iliac artery. All visceral arteries branched from the false lumen. The maximum diameter of the thoracic aneurysm was 4.8cm and that of the abdominal aneurysm was 6.5cm. Multiple renal infarcts were noted and the right kidney function was decreased. Initial surgery was performed 3 months after presentation using a graft technique. Advanced atherosclerosis and dissection were noted in the aneurysm making the arterial wall quite vulnerable. Hemorrhage was extensive and hemostasis difficult in the defective arterial wall. The patient became unstable so the aneurysm was closed and the surgical procedure was changed to right axillo-bifemoral bypass rather than the original surgical plan of anatomic reconstruction of the AAA. The patient tolerated the procedure well. We report a rare case of acute aortic dissection which extended through the AAA.

Participants in our screening program for cerebrovascular disease are supposed to receive thyroid checkups at the time of ultrasound imaging of carotid arteries. Thus far, a total of 4,338 people have participated in this program. Of the total, 17 cases of papillary thyroid carcinoma were found (detection ratio: 0.39%). This study concerned with the 13 cases which underwent surgical treatment in our hospital. They all were diagnosed as early cancers--eight cases at stage N0 and five cases at stage N1--with an average tumor diameter of 11 mm. Besides, five cases of Basedow's disease (hyperthyroidism) and 15 cases of chronic thyroiditis were found (detection ratio: 0.35%). Of the 15 chronic thyroiditis cases, nine were found to have symptoms of hypothyroidism. We concluded that our screening program for cerebrovascular disease involving the ultrasonographic scans of the thyroid gland is very helpful not only in detecting malignancies at an early stage but also in screening for functional abnormalities of the thyroid.
Aspects of disease screening ; Ultrasonography ; Desiccated thyroid ; Thyroid Gland ; Diagnostic Neoplasm Staging