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Aortic dissection with pericardial rupture and tamponade
History
81 y/o man with a history of hypertension and hypercholesterolema found unconcious in nursing home.
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Findings
The AP view of the chest shows widening of the mediastinum and cardiomegally. The contrast enhanced CT images show a Stanford type A dissection of the ascending aorta extending retrograde down to the aortic root and rupturing into the pericardial sac causing tamponade.
Discussion
Aortic dissection is associated with hypertension, Marfan's syndrome and a bicuspid aortic valve. It commonly extends antegrade from either close to the aortic root (Type A) or just beyond the left subclavian artery (Type B). Less common is retrograde extension with rupture into the pericardial sac. There is about a 80% mortality within the first 2 weeks and an operative mortality of 25%. Management includes controlling hypertension. Reasons for surgical management include an enlarging aorta and in this case, pericardial tamponade.
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