Methodist Journal

IN THIS ISSUE

Diabetes and the Heart

Vol 14, Issue 4 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

The Intersection of Diabetes and Cardiovascular Disease

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RECOGNITIONS

Guest Editors Steven Petak and Archana Sadhu Guide Issue on Diabetes and the Heart

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REVIEW ARTICLES See More

Cardiac Autonomic Neuropathy in Diabetes Mellitus

Stage-Based Management of Type 2 Diabetes Mellitus with Heart Failure

Imaging to Stratify Coronary Artery Disease Risk in Asymptomatic Patients with Diabetes

Update on Management of Type 2 Diabetes for Cardiologists

New Therapeutic Strategies for Type 2 Diabetes

Prediabetes: Why Should We Care?

Central Venous Pathologies: Treatments and Economic Impact

Venous Thrombosis and Post-Thrombotic Syndrome: From Novel Biomarkers to Biology

CASE REPORTS See More

Loperamide Mimicking Brugada Pattern

Reversed Pulsus Paradoxus in Right Ventricular Failure

Mycobacterium Chimaera Mimicking Sarcoidosis

Immune Checkpoint Inhibitor Related Cardiotoxicity

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

A Right Ventricular Mass

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

The Kidney as an Endocrine Organ

EXCERPTA

The Other Side of the Prescription

EXCERPTA

Telemedicine Shakes Up the ICU Experience

POINTS TO REMEMBER

Venous Thrombosis in Nephrotic Syndrome

EDITORIALS

Letter to the Editor in response to “Role of Subcutaneous Leadless Implantable Cardioverter Defibrillator in Young Patients

Vol 14, Issue 1 (2018)

Article Full Text

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER

Ruptured Aortic Pseudoaneurysm: An Unusual Cause of Recurrent Lightheadedness and Cough

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Article Citation:

DaSilva-DeAbreu A, Moore AE, Arain S. Ruptured Aortic Pseudoaneurysm: An Unusual Cause of Recurrent Lightheadedness and Cough. Methodist DeBakey Cardiovasc J. 2018;14(1):66-67.

doi: 10.14797/mdcj-14-1-66

Keywords
ascending aorta , pseudoaneurysm , mediastinal hematoma , cardiopulmonary bypass

CASE PRESENTATION

A 60-year-old man with end-stage renal disease was referred to the emergency room for hypotension during dialysis. He had a history of hypertension, atrial fibrillation, heart failure with preserved ejection fraction, and recurrent methicillin-sensitive Staphylococcus aureus (MSSA) mitral endocarditis with embolic stroke. He had recently undergone surgical mitral repair complicated by ascending aortic pseudoaneurysm with a surrounding stable hematoma (3.8 x 6.7 x 9.3 cm) (Figure 1), for which he was planning elective surgery.

At the time of presentation, the patient only complained of a several-day history of episodic lightheadedness. He was hypotensive (90/50 mm Hg) and tachycardic (114 beats/min). A computed tomography angiography showed a ruptured pseudoaneurysm with “swirl sign” (Figure 2 A). The hematoma had enlarged (9.6 x 12.2 x 14 cm), compressing the mediastinal vessels and trachea with right ventricular strain (Figure 3). There was active blood flow extravasating into the hematoma (Figure 2). Hemoglobin was at baseline (9.9 g/dL). The patient underwent pseudoaneurysm resection and aortic reconstruction. Cultures of the pseudoaneurysm grew MSSA. He was treated with cefazolin and his symptoms resolved.

Figure 1.
Figure 2.
Figure 3.

Ascending aortic pseudoaneurysms are uncommon but potentially fatal.1,2 Typical findings include intense chest pain and hypotension, and survival depends on early diagnosis and surgery. This case is notable for its atypical, relatively indolent course and low bleeding rate despite the swirl sign. Furthermore, compression of mediastinal structures seems to have been the cause of his unusual symptoms rather than hypovolemia or pain.

This case illustrates how ruptured aortic pseudoaneurysm can present with benign symptoms. Physicians should be highly suspicious when evaluating patients with an atypical constellation of symptoms after cardiothoracic surgery. Timely imaging can help to promptly diagnose the condition and plan interventions.

References

1. Sullivan KL, Steiner RM, Smullens SN, Griska L, Meister SG. Pseudoaneurysm of the ascending aorta following cardiac surgery. Chest.
1988 Jan;93(1):138-43.
2. Razzouk A, Gundry S, Wang N, et al. Pseudoaneurysms of the aorta after cardiac surgery or chest trauma. Am Surg. 1993 Dec;59(12):818-23.

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