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隐匿于众目睽睽之下:解读胸痛、高血压和肌酐升高以揭示主动脉夹层。

Hidden in Plain Sight: Deciphering Chest Pain, Hypertension, and Elevated Creatinine to Unveil Aortic Dissection.

作者信息

Sudeepa Karumanchi, K Mythili, Sai Manasa Nemani, Kumar J S, C Nirmala

机构信息

Internal Medicine, Sri Ramaswamy Memorial Institute of Science and Technology (SRMIST), Chennai, IND.

General Medicine, Sri Ramaswamy Memorial Institute of Science and Technology (SRMIST), Chengalpattu, IND.

出版信息

Cureus. 2024 Jul 31;16(7):e65892. doi: 10.7759/cureus.65892. eCollection 2024 Jul.

Abstract

Chest pain is a common yet complex presentation in the emergency department, often requiring the exclusion of life-threatening conditions such as aortic dissection. Stanford type B aortic dissection, which affects the descending aorta, poses significant diagnostic and therapeutic challenges but can often be managed medically without immediate surgery. This case underscores the necessity of having a vigilant mindset, performing a detailed clinical examination, and including aortic dissection in the differential diagnosis, especially when typical symptoms are observed. The challenging part of this case was the investigation, as computed tomography angiography couldn't be performed, necessitating the use of magnetic resonance imaging for diagnosis. It highlights the importance of individualized patient care, vigilant monitoring, and comprehensive management strategies in the treatment of aortic dissection.

摘要

胸痛是急诊科常见但复杂的症状表现,通常需要排除诸如主动脉夹层等危及生命的疾病。累及降主动脉的B型主动脉夹层带来了重大的诊断和治疗挑战,但通常可通过内科治疗而无需立即手术。本病例强调了保持警惕心态、进行详细临床检查以及在鉴别诊断中考虑主动脉夹层的必要性,尤其是在观察到典型症状时。该病例具有挑战性的部分在于检查,由于无法进行计算机断层血管造影,因而需要使用磁共振成像进行诊断。它凸显了在主动脉夹层治疗中个体化患者护理、密切监测和综合管理策略的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db04/11364702/d33180cddad5/cureus-0016-00000065892-i01.jpg

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