Maezawa Yosuke, Nagasaki Kazuya, Kobayashi Hiroyuki, Sakai Shunsuke, Irie Toshiyuki
Mito Kyodo General Hospital, Department of Internal Medicine, University of Tsukuba, Mito, Japan.
Mito Kyodo General Hospital, Department of Cardiology, University of Tsukuba, Mito, Japan.
Clin Pract Cases Emerg Med. 2024 Nov;8(4):372-374. doi: 10.5811/cpcem.20340. Epub 2024 Jul 26.
An 86-year-old female presented to our emergency department with chest pain and orthopnea and was diagnosed with heart failure and ST-elevation myocardial infarction, prompting hospitalization. During hospitalization, she developed a fever. A chest and abdominal contrast-enhanced computed tomography (CT), conducted to investigate the cause of the fever, coincidentally revealed sedimentation of contrast agent in the descending aorta. To differentiate from aortic dissection, we conducted dynamic CT, and it was confirmed that the contrast agent within the aorta decreased over time. On the same day, an echocardiogram revealed a left ventricular ejection fraction of 36% with reduced contractile function, and a stagnant, hazy echo within the descending aorta.
In aortic dissection, the retention of contrast agent in the false lumen of the aorta is a crucial finding for diagnosis. However, we experienced a case where contrast agent accumulated in the descending aorta, caused by low ejection fraction of the left ventricle. Differential diagnosis from aortic dissection may be possible due to the gradual decrease in contrast agent over time. This case is valuable to report given the limited number of previous reports on this phenomenon.
一名86岁女性因胸痛和端坐呼吸就诊于我院急诊科，被诊断为心力衰竭和ST段抬高型心肌梗死，遂住院治疗。住院期间，她出现发热。为调查发热原因进行的胸部和腹部对比增强计算机断层扫描（CT）意外发现降主动脉内造影剂沉积。为与主动脉夹层相鉴别，我们进行了动态CT检查，证实主动脉内的造影剂随时间减少。同一天，超声心动图显示左心室射血分数为36%，收缩功能降低，降主动脉内回声停滞、模糊。
在主动脉夹层中，造影剂在主动脉假腔内潴留是诊断的关键发现。然而，我们遇到了一例因左心室射血分数低导致造影剂在降主动脉内积聚的病例。由于造影剂随时间逐渐减少，可能与主动脉夹层进行鉴别诊断。鉴于此前关于这一现象的报道数量有限，报道此病例很有价值。
