Acute aortic syndrome
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Acute aortic syndrome (AAS) describes a range of severe, painful, potentially life-threatening abnormalities of the aorta.[1] These include aortic dissection, intramural thrombus, and penetrating atherosclerotic aortic ulcer.[2] AAS can be caused by a lesion on the wall of the aorta that involves the tunica media, often in the descending aorta.[3] It is possible for AAS to lead to acute coronary syndrome.[4] The term was introduced in 2001.[5][6]
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[edit] Causes
Causes can include aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer or a thoracic aneurysm that has become unstable.[7] The potential causes of AAS are life-threatening and present with similar symptoms, making it difficult to distinguish the ultimate cause, though high resolution, high contrast computerised tomography can be used.[7][8]
[edit] Diagnosis
The condition can be mimicked by a ruptured cyst of the pericardium,[9] ruptured aortic aneurysm[8] and acute coronary syndrome.[10]
Misdiagnosis is estimated at 39% and is associated with delays correct diagnosis and improper treatment with anticoagulants producing excessive bleeding and extended hospital stays.[10]
[edit] Management
AAS is life-threatening, with a high mortality rate if appearing acutely, reduced only when diagnosed early and treated by a surgeon with considerable expertise.[3] If patients survive acute presentation, within three to five years 30% will develop complications and require close follow-up.[3] Early diagnosis is essential for survival and management is challenging though greater awareness of the syndrome and improving management strategies are improving patient outcomes.[11]
[edit] References
- ^ Ahmad F, Cheshire N, Hamady M (May 2006). "Acute aortic syndrome: pathology and therapeutic strategies". Postgrad Med J 82 (967): 305–12. doi:. PMID 16679467.
- ^ Macura, KJ; Corl FM, Fishman EK, Bluemke DA (August 2003). "Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer". American Journal of Roentgenology 181 (2): 309–316. PMID 12876003.
- ^ a b c Evangelista Masip A (April 2007). "[Progress in the acute aortic syndrome]" (in Spanish; Castilian). Rev Esp Cardiol 60 (4): 428–39. PMID 17521551.
- ^ Manghat NE, Morgan-Hughes GJ, Roobottom CA (December 2005). "Multi-detector row computed tomography: imaging in acute aortic syndrome". Clin Radiol 60 (12): 1256–67. doi:. PMID 16291307.
- ^ van der Loo B, Jenni R (August 2003). "Acute aortic syndrome: proposal for a novel classification". Heart 89 (8): 928. PMID 12860875.
- ^ Vilacosta I, Román JA (April 2001). "Acute aortic syndrome". Heart 85 (4): 365–8. PMID 11250953.
- ^ a b Smith AD, Schoenhagen P (January 2008). "CT imaging for acute aortic syndrome". Cleve Clin J Med 75 (1): 7–9, 12, 15–7 passim. PMID 18236724.
- ^ a b Marijon E, Vilanculos A, Tivane A, et al (2007). "Thoracic aortic aneurysm: direct sign of rupture" (pdf). Cardiovasc J Afr 18 (3): 180–1. PMID 17612751.
- ^ Nishigami K, Hirayama T, Kamio T (February 2008). "Pericardial cyst rupture mimicking acute aortic syndrome". Eur. Heart J.. doi:. PMID 18296680.
- ^ a b Hansen MS, Nogareda GJ, Hutchison SJ (March 2007). "Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection". Am. J. Cardiol. 99 (6): 852–6. doi:. PMID 17350381.
- ^ Ince H, Nienaber CA (May 2007). "[Management of acute aortic syndromes]" (in Spanish; Castilian). Rev Esp Cardiol 60 (5): 526–41. PMID 17535765.
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