Images in Clinical Medicine
Circumferential Dissection of the Aorta
N Engl J Med 1999; 340:1553May 20, 1999
- Article
Figure 1 A 68-year-old woman was admitted to the emergency room with sudden left hemiparesis. A computed tomographic scan of the brain showed an image consistent with infarction of the right frontal lobe. A transthoracic echocardiogram suggested that dissection of the ascending aorta had occurred. Transesophageal echocardiography was performed immediately thereafter and confirmed the diagnosis. A wide dissection of the proximal aorta compromised more than 270 degrees of the vessel's circumference and extended to the descending thoracic aorta. The redundant, dissected wall was plicated, producing a wave-shaped image in the transverse plane of the echocardiogram (Panel A) and duplicated aortic planes, with two lines (Panel B) or four lines (Panel C), in the longitudinal plane. The patient died two hours after admission, before surgery could be performed.
In this patient, aortic dissection had occurred painlessly, with ischemic stroke as its only symptom. The circumferential dissection produced not only uncommon echocardiographic images but also flap intussusception, leading to an ischemic stroke.
Daniel J. Piñeiro, M.D.
Claudio A. Bellido, M.D.
University of Buenos Aires, Buenos Aires 1195, Argentina
