Qarajeh Raed, Lehenbauer Kyle, Elkaryoni Ahmed, Derbas Laith, Tanenbaum Robert
Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA.
Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, USA.
Cureus. 2020 May 27;12(5):e8322. doi: 10.7759/cureus.8322.
Ascending (type A) aortic dissection can rarely result in contained transverse pericardial sinus hematoma that compresses adjacent structures making diagnosis more challenging. We present a rare case of a 77-year-old man who presented with sudden-onset chest pain and was admitted for a presumed acute coronary syndrome. Coronary angiography did not show significant stenosis and ruled out acute coronary syndrome. Transthoracic echocardiogram showed extracardiac structure compressing on the left atrium; hence, we performed transesophageal echocardiogram which confirmed aortic dissection and revealed a hematoma in the transverse pericardial sinus. Intraoperatively, a large hematoma in the transverse pericardial sinus was extracted and revealed a posterior perforation of the ascending aorta that extended into the left atrium.
升主动脉（A型）夹层很少会导致局限于横心包窦的血肿，这种血肿会压迫相邻结构，使诊断更具挑战性。我们报告一例罕见病例，一名77岁男性，突发胸痛入院，初步诊断为急性冠状动脉综合征。冠状动脉造影未显示明显狭窄，排除了急性冠状动脉综合征。经胸超声心动图显示心外结构压迫左心房；因此，我们进行了经食管超声心动图检查，证实为主动脉夹层，并发现横心包窦内有血肿。术中，取出横心包窦内的一个大血肿，发现升主动脉后壁穿孔并延伸至左心房。
