Aortic dissection presenting as upper airway obstruction.

plasmose generalisse avec localisation laryngee et endocaroite. An acute aortic dissection with rupture in the descending aorta led to suffusion of blood into the soft tissue of the neck with sufficient pressure to cause not only superior vena cava obstruction, but also trachea! obstruction. RA = right atrium; LA = left atrium; PA = pulmonary artery; Th = thrombus. Airtic dissection results from a tear in the aortic intima which allows blood to enter the aortic media and may then propagate distally and on occasion, proximally. Known risk factors for aortic dissection include hypertension, congenital abnormalities of the aortic valve, coarctation of the aorta, Marhm's syndrome, other connective tissue dis orders and iatrogenic causes. The clinical presentation of aortic dissection can be quite variable and is often related to alteration in end-organ blood supply. The most common symptom is chest pain which is present in nearly all cases.' Other common presenting features include syncope, dysp nea, neurologic impairment, aortic insufficiency, and left pleural effusion. Less frequent findings include vocal cord paralysis. Homers syndrome, hemoptysis, hematemesis, heart block and, rarely, superior vena cava (SVC) syndrome.' The following report describes a patient with acute aortic dissection presenting with symptoms of upper airway ob struction. CASEREPORT The patient was a 6.5-year-old Caucasian man who had previously l>een well. On the day oi admission, the patient had sudden onset FIGURK 1. Patient is intubatecl. Measuring tape across neck reveals degree of swelling.