Munín Martín, Goerner María S, Lombardero Martín, Sanchez Gustavo, Redondo Juan C Pereira, Spernanzoni Fernando, Lardani Héctor, Torres Víctor
Department of Echocardiography, CEMIC, Hospital Universitario Saavedra, Av, E, Galván 4102 Capital Federal Buenos Aires C1431FWO, Argentina.
Cardiovasc Ultrasound. 2007 Jan 3;5:1. doi: 10.1186/1476-7120-5-1.
The occurrence of pulmonary artery obstruction in the course of acute aortic dissection is an unusual complication. The mechanism implicated is the rupture of the outer layer of the aorta and the subsequent hemorrhage into the adventitia of the pulmonary artery that causes its wall thickening and, at times, produces extrinsic obstruction of the vessel. There are no reports of this complication in acute intramural hematoma.
An 87-year-old woman was admitted to the hospital in shock after having had severe chest pain followed by syncope. An urgent transesophageal echocardiogram revealed the presence of acute intramural hematoma, no evidence of aortic dissection, severe pericardial effusion with cardiac tamponade, and periaortic hematoma that involved the pulmonary artery generating circumferential wall thickening of its trunk and right branch with no evidence of flow obstruction. Urgent surgery was performed but the patient died in the operating room. The post mortem examination, in the operating room, confirmed that there was an extensive hematoma around the aorta and beneath the adventitial layer of the pulmonary artery, with no evidence of flow obstruction.
This is the first time that this rare complication is reported in the scenario of acute intramural hematoma and with the transesophageal echocardiogram as the diagnostic tool.
急性主动脉夹层病程中发生肺动脉梗阻是一种罕见的并发症。其潜在机制是主动脉外层破裂，随后血液渗入肺动脉外膜，导致其管壁增厚，有时还会造成血管外部梗阻。目前尚无急性壁内血肿出现这种并发症的报道。
一名87岁女性在出现严重胸痛并伴有晕厥后，因休克入院。紧急经食管超声心动图显示存在急性壁内血肿，无主动脉夹层证据，有严重心包积液伴心脏压塞，以及主动脉周围血肿累及肺动脉，导致其主干和右分支管壁周向增厚，但无血流梗阻证据。遂进行紧急手术，但患者在手术室死亡。手术室的尸检证实，主动脉周围和肺动脉外膜层下方存在广泛血肿，无血流梗阻证据。
这是首次在急性壁内血肿情况下，以经食管超声心动图作为诊断工具报道这种罕见并发症。
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