DISSECTING ANEURYSM

DISSECTING ANEURYSM


                                 DISSECTING ANEURYSM  (Dissecting hematoma)

  • Dissecting aneurysm is dissecting hematoma which  occurs when a defect or flap occurs in the intima of the aorta, resulting in blood tracking into the aortic tissues splitting the medial layer and crearing a false lumen.
  • MC site is aorta (right lateral wall of ascending aorta)

a) Ascending aorta 70%

b) Descending aorta 63%

  

RISK FACTORS-

  • Hypertension (MC)
  • Cystic medial necrosis
  • Pregnancy
  • Marfan syndrome
  • Ehler’s Danlos syndrome
  • Turner syndrome

 

CLINICAL FEATURES-

  • More common in males (50- 70 years)
  • Stroke, paraplegia, pericardial tamponade, diaphoresis.
  • Abdominal pain

 

CLASSIFICATION-

  1. Debakey Classification-
  • According to extent of aortic dissection-
  1. Type I
  • Initimal tear in ascending aorta involving descending aorta (MC)

     2. Type II

  • Dissection is limited to ascending aorta.

     3. Type III

  • Initimal tear in descending aorta which distal propogation.

  

    B. Standford classification-

  • According to clinical management-
  1. Type A (proximal dissection)

a) Type A- I and II of Debake’s classification

b) Type B- III Debake’s classification

 

CLINICAL FEATURES-

  • Excruciating tearing pain in chest
  • Dyspnea
  • Weakness
  • Hypotension/ shock

 

INVESTIGATIONS-

  • Chest X-ray
  • Stable- CT angiography
  • Unstable- Transesophageal echocardiography

 

TREATMENT-

  • Emergency Dacron graft repair

Exam Important

  • Dissecting aneurysm is dissecting hematoma which  occurs when a defect or flap occurs in the intima of the aorta, resulting in blood tracking into the aortic tissues splitting the medial layer and crearing a false lumen.
  • MC site is aorta (right lateral wall of ascending aorta)
RISK FACTORS-

  • Hypertension (MC)
  • Cystic medial necrosis
  • Pregnancy
  • Marfan syndrome
  • Ehler’s Danlos syndrome
  • Turner syndrome
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