Successful Repair of Concomitant Acute Type A Aortic Dissection and Saddle Pulmonary Embolism

Abstract

Patients presenting with acute onset of chest pain require prompt diagnosis and rapid establishment of a management plan. Acute aortic dissection and acute pulmonary embolism are life-threatening emergencies that can mimic each other at presentation. Correct identification of this uncommon scenario is crucial to initiate the appropriate interventions. The authors present a unique case of concomitant acute type A aortic dissection and acute saddle pulmonary embolism; the patient underwent successful aortic repair and pulmonary embolectomy.

Simultaneous Aortic Dissection and Pulmonary Embolism: A Therapeutic Dilemma

“…The incidence of aortic dissection is about 15 cases for 100,000 patient-years and accounts for 85-95% of acute aortic syndromes [ 3 , 19 ]. Pulmonary embolism has an incidence of about 112 cases per 100,000 patient-years [ 3 ]. Both of these cases have high mortality and the mortality rate further increases when they present together.…”

“…Simultaneous occurrence of aortic dissection and pulmonary embolism is not so common; some cases have been published about their simultaneous occurrence [3,5,[11][12][13][14]. Though both of the cases can present with atypical chest pain, either aortic dissection or pulmonary embolism is the main presenting complains and the other one is an incidental finding in most cases.…”

“…Stanford type A aortic dissection is more common than type B [ 1 ]. The most common risk factors are hypertension and smoking [ 2 , 3 ]. On the other hand, pulmonary embolism is a common diagnosis, the third most common cardiovascular disease after acute coronary syndrome and stroke [ 4 ].…”

Images in Vascular Medicine: Pulmonary embolism and acute aortic syndromes – Double trouble when vascular medicine emergencies meet

“…PE and acute aortic syndromes are vascular emergencies that may occur in close succession. 3 Their recognition and management require a team with expertise in both conditions such that the "uninvited guest" of a second vascular medicine emergency is recognized and treated.…”

Atypical manifestations of pulmonary embolism

“…The authors hypothesized that this might, in part, be attributable to compression of the superior vena cava leading to venous stasis and heightened risk of thrombus formation [81]. Among nine anecdotal reports of the association of TAD and PE [66][67][68][82][83][84][85][86][87] there were four instances of coexisting DVT [66,68,83,87].…”