Methodist Journal

IN THIS ISSUE

Lipids and Lipoproteins

Vol 15, Issue 1 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

Lipids and Cardiovascular Disease: Putting it All Together

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RECOGNITIONS

Guest Editors Henry Pownall and Antonio Gotto Offer Insight and Expertise on the topic of Lipids and Cardiovascular Disease

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REVIEW ARTICLES See More

Cholesterol: Can’t Live With It, Can’t Live Without It

How Much Do Lipid Guidelines Help the Clinician? Reading Between the (Guide)lines

Statins: Then and Now

Poststatin Lipid Therapeutics: A Review

HDL and Reverse Cholesterol Transport Biomarkers

Revisiting Reverse Cholesterol Transport in the Context of High-Density Lipoprotein Free Cholesterol Bioavailability

High-Density Lipoprotein Subspecies in Health and Human Disease: Focus on Type 2 Diabetes

Gene Delivery in Lipid Research and Therapies

CASE REPORTS See More

Device-Related Thrombus: A Reason for Concern?

Retained Coronary Balloon Requiring Emergent Open Surgical Retrieval: An Uncommon Complication Requiring Individualized Management Strategies

Loperamide Mimicking Brugada Pattern

Reversed Pulsus Paradoxus in Right Ventricular Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Transcatheter Embolization of a Persistent Vertical Vein: A Rare Cause of Left-to-Right Shunt and Right-Sided Heart Failure

CLINICAL PERSPECTIVES See More

EXCERPTA

Talking Statins with Antonio Gotto

POINTS TO REMEMBER

Lipids and Renal Disease

EXCERPTA

Addressing the Feedback Loop Between Depression, Diabetes, and Cardiovascular Disease

POINTS TO REMEMBER

The Kidney as an Endocrine Organ

EDITORIALS

Addressing the Underrepresentation of Women in Cardiology through Tangible Opportunities for Mentorship and Leadership

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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