THORACOABDOMINAL AORTIC DISSECTION: ATYPICAL PRESENTATION AND MULTIORGAN DAMAGE

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Acute Aortic Dissection (AoD) is the disruption of tunica intima and media aortic wall forming a blood-filled dissection plane dividing into "true" "false" lumen. We categorize AoD as Type A B (Stanford classification) based on part aorta involved. However, an accurate diagnosis difficult due to inconsistent clinical presentations (typically present with tearing chest pain radiating back). This unique case atypical presentation complicated course. CASE PRESENTATION: 53-year-old man untreated hypertension presented emergency room (ER) worsening right lower extremity (RLE) numbness for 6 days, aggravated ambulation along quadrant (RLQ) abdominal pain. He endorses extensive tobacco, alcohol, marijuana, cocaine use. In ER, blood pressure was 275/142 mmHg, biventricular hypertrophy EKG. also had RLQ tenderness diminished pulses in RLE. The computed tomography (CT) discovered distal division. larger false lumen dissected left renal artery, common iliac thrombosis internal artery. narrow true minimizes perfusion RLE kidney. CT angiography confirmed Stanford intimal tear subclavian Intravenous Nicardipine Esmolol drip controlled pressure, followed by femorofemoral bypass improve perfusion. Post-operative contrast nephropathy improved day 10. Subsequently, persistent ileus poor intestinal corrected transverse loop colostomy 15. On 20, patient discharged oral antihypertensive medications. DISCUSSION: incidence 5-30 per million people year. 38% ER are missed; 28% diagnosed at autopsy. Hypertension, atherosclerosis, abuse, cardiac surgeries, systemic inflammatory syndromes can increase risk. Sullivan et al. suggest that physician suspects 86% patients back pain, 45% only 8% Our combination (abdominal leg numbness) significant malperfusion RLE, small bowel, kidney (IRAD registry). For dissection, medical management preferred surgical techniques Estimated inpatient mortality 30% proximal 10% dissection. After acute phase, 10-year survival rate <50%. CONCLUSIONS: Even symptoms, associated complications were successfully treated. current advancements, controversies regarding diagnosis, timing repair, type repair still exist. REFERENCE #1: Cebicci, Huseyin & Salt, Omer Gurbuz, Sukru Sahin, Taner Cumaoglu, Mustafa Koyuncu, Serhat. (2014). Atypical dissections: series. Acta Medica Mediterranea. 30. 85-90. #2: PR, Wolfson AB, Leckey RD, Burke JL. Diagnosis thoracic department. Am J Emerg Med. 2000 Jan;18(1):46-50. doi: 10.1016/s0735- 6757(00)90047-0. PMID: 10674531 #3: Crawford, Todd C, "Malperfusion Syndromes Dissections." Vascular Medicine, vol. 21, no. 3, 2016, pp. 264–273., doi:10.1177/1358863x15625371 DISCLOSURES: No relevant relationships Saurabh Chokshi, source=Web Response David Goldgrab, Devansh Patel, no disclosure file Jorge Perez