Year: 2025
Type: article
Study design: Case Report
Abstract: Prikaz slučaja Case reportSAŽetAK: Prikazujemo slučaj asimptomatske -bezbolne, Stanford A disekcije aorte koja je otkrivena na kompjutoriziranoj tomografskoj angiografiji koronarnih arterija.Bolesnik, 82-godišnji muškarac, bez anamnestičkih podataka o prethodno dijagnosticiranim bolestima ili kroničnoj terapiji, hospitaliziran je radi evaluacije zbog kliničkih i subjektivnih znakova zatajivanja srca.Negirao je bilo kakvu vrstu boli u prsnom košu, prije ili tijekom boravka u bolnici.Na transtorakalnoj ehokardiografiji pronađena je dilatacija aorte s umjerenom aortalnom regurgitacijom (bez intimalnog rascijepa na prikazu u lijevoj parasternalnoj dugoj osi), ejekcijska frakcija lijeve klijetke bila je uredna te nije bilo znakova perikardijalnog izljeva.Zbog sumnje na ishemijski incident (dinamika elektrokardiograma tijekom boravka u bolnici, no bez tegoba) upućen je na kompjutoriziranu tomografsku angiografiju koronarnih arterija na kojoj je konstatirana višežilna koronarna bolest srca sa stenozama do 60 %, ali i intimalni flap u uzlaznoj aorti -Stanford A disekcija, što je potom dodatno potvrđeno kompjutoriziranom tomografskom angiografijom cijele aorte.Bolesnik je odbio preporučeno kirurško liječenje i napustio bolnicu na vlastit zahtjev, a preporučena mu je medikamentna terapija i praćenje.Zbog varljivosti kliničke slike i diferencijalno dijagnostičkog izazova, promptna dijagnoza disekcije aorte kao medicinske hitnosti izazov je u svakodnevnoj kliničkoj praksi pa stoga treba uzeti u obzir njezine atipične oblike u smislu kliničke prezentacije i rezultata slikovnih dijagnostičkih metoda. SUMMARY:We present a case of an asymptomatic, painless, Stanford type A aortic dissection (AD) that was discovered on computed tomography coronary angiography.The patient, a 82-year-old man, who had no previous medical records and no prescribed chronic therapy, presented with clinical and subjective signs of congestive heart failure and was hospitalized for further assessment.He denied any type of chest pain, whether before or during hospital stay.On transthoracic echocardiography, aortic dilatation with moderate aortic regurgitation was found (without the intimal flap on the left parasternal long axis view), left ventricular ejection fraction was preserved, and there were no signs of pericardial effusion.Due to the suspicion of an ischemic incident (the electrocardiogram was dynamic, the patient remained painless), the patient was referred for a computed tomography coronary angiogram, which revealed multivessel coronary artery disease with stenosis up to 60%, but also an intimal flap in the ascending aorta -Stanford type A dissection, which was then further confirmed by computed tomography angiography of the aorta.The patient refused the recommended surgical treatment, left the hospital at his own request, and was recommended drug therapy and follow-up.Because of the deceptiveness of clinical presentation and challenging differential diagnosis, prompt diagnosis of AD as a medical emergency remains a challenge in everyday clinical practice, and its atypical forms in terms of clinical presentation and imaging tests should be taken into account.
Source: Cardiologia Croatica
DOI: 10.15836/ccar2025.69
Institution: Clinical Center University of Sarajevo
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408053758