HISTOPATHOLOGY AIDING IN THE DIAGNOSIS OF AN ATYPICAL CASE OF AORTIC DISSECTION

TOPIC: Cardiothoracic Surgery TYPE: Medical Student/Resident Case Reports INTRODUCTION: Aortic dissection (AD) often presents as acute severe chest or back pain and hemodynamic compromise[1,2]. Early accurate diagnosis treatment are crucial for survival. Multiple imaging modalities can be used to demonstrate the dissection, including Computed Tomographic Angiography (CTA), Magnetic Resonance (MRA), Transesophageal Echocardiography (TEE). We present a case where patient with atypical presentation of AD underwent multiple diagnostic studies inconsistent results. CASE PRESENTATION: A 47-year-old male history hypertension, asthma, tobacco use presented sudden onset left-hand numbness, tingling, associated changes color in his hand. Patient had sensory deficits left hand big toe. upper extremity (LUE) venous duplex was unremarkable. CTA showed filling defect right posterior ascending aorta suggestive an intimal flap. Esmolol initiated. TEE did not reveal AD. Heparin Arterial Doppler LUE negative any atherosclerotic thrombotic diseases evidence obstruction. The following day, experienced crushing radiating back. Transthoracic echocardiogram aorta. operated on emergently. Although frank observed, mobile pedunculated mass reported. affected segment resected graft repair. Histopathology results focal adventitial hemorrhage degenerative medial consistent DISCUSSION: In this made early due symptoms inconclusive studies. definitive through histopathology, even inspection at time surgery AD, given unusual gross appearance. Painless is encountered only 6.4% cases [3]. Conventional CT scanning has sensitivity 83-95% but it drops <80% aorta[4-7]. MRA typically performed next confirm diagnosis. Despite 98%[8,9], unremarkable case. features presence tear, near layer, degeneration confirmed recent large cardiovascular registry, >60% were first identified autopsy[10,11]. CONCLUSIONS: This represents challenge highlights possibility uncommon importance taking into consideration case, appearance during surgery, histopathology necessary It extraordinarily rare require surgery. REFERENCE #1: 1.Hagan PG, Nienaber CA, Isselbacher EM, et al. International Registry Acute Dissection (IRAD): new insights old disease. JAMA 2000; 283:897 #2: 2. Evangelista A, Bossone E, Insights From Dissection: 20-Year Experience Collaborative Clinical Research. Circulation 2018; 137:1846. 3. Fatima S, Sharma K. Dissection-Diagnostic Dilemma With Fatal Outcomes: What Do Learn?. J Investig Med High Impact Rep. 2017;5(3):2324709617721252. 4. von Kodolitsch Y, Nicolas V, thoracic aortic by noninvasive procedures. N Engl 1993; 328:1. 5. LePage MA, Quint LE, Sonnad SS, dissection: that distinguish true lumen from false lumen. AJR Am Roentgenol 2001; 177:207. #3: 6. Shiga T, Wajima Z, Apfel CC, Diagnostic accuracy transesophageal echocardiography, helical computed tomography, magnetic resonance suspected systematic review meta-analysis. Arch Intern 2006; 166:1350. 7. Hayter RG, Rhea JT, Small Suspected other disorders: multi-detector row 373 emergency setting. Radiology 238:841. 8. Moore AG, Eagle KA, Bruckman D, Choice imaging, aortography (IRAD). Cardiol 2002; 89:1235. 9. Hartnell G, Costello P. 328:1637; author reply 1638. 10. Hosoda Y. [Pathology dissection]. Nihon Geka Gakkai Zasshi. 1996 Oct;97(10):873-8. 11. Huynh N, Thordsen Thomas Mackey-Bojack SM, Duncanson ER, Nwuado Garberich RF, Harris KM. pathologic findings autopsy: Review 336 over nearly 6 decades. Heart J. 2019 Mar;209:108-115. DISCLOSURES: No relevant relationships Matthew Darrow, source=Web Response Muhammad Mufty, Pradyumna Tummala,