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Journal of The Korean Society of Emergency Medicine 1994;5(2): 225-232. |
| CLINICAL FEATURES OF AORTIC DISSECTING ANEURYSM |
| Seung Hyun Park, Kyu Nam Park, Dong Ryeol Oh, Ki Joong Lee, Byung Ho Nah, Se Kyung Kim, Keun Woo Lim |
| Department of Emergency Medicine Catholic University Medical College |
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Published online: December 31, 1994. |
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| ABSTRACT |
Dissecting aortic aneurysm is the most fatal disease involving the aorta that can be resulted in a life-threatening outcome unless a prompt diagnosis and an appropriate treatment is done.
A retrospective clinical study was done on 51 cases of dissecting aortic aneurysm who had been admitted to department of Emergency Medicine, St. Mary's hospital, Kangnam, CUMC. from Jan, 1990 to Sep. 1994, in aspects of locations of pain, ECGs, and chest X-rays.
The mean age at admission was 61.4 years old ( range ; 31-88). It was seen more frequently in male than femole with M : F ratio of 2 : 1. Hypertension was the most freqent predisposing factor( 70.6 % ). According to the DeBakey classification, type I was found in 29.4 %, type II in 11.4%, type Ⅲ in 58.8%. The most frequent symptom was a pain in 44 cases(86.3% ), no pain in 7 cases( 13.7% ). Painful symptoms were back pain in 25 cases(73% ), chest pain in 19 cases(55.9% ), epigastric pain in 12 cases(35.3% ), abdominal pain in 3 cases(8.8% ). Painless symptoms were 5 cases in type I , II, 2 cases in type Ⅲ. ECG showed normal in 29 cases(56.9
% ), LVH(Left Vontricular Hypertrophy) in 13 cases(25.5% ), BBB(Bundle Branch Block) in 5 cases(9.8%), ST segment depression in 3 cases(5.9%), Atrial fibrillation in 1 cases(1.9%). Me diastinal widenings on chest PA, erect or sitting position, were found in 63 %, in comparison with control group.(p<.05). The average mediastinal length was 10.39cm in type I , 10.82cm in type II , 8.89cm in type Ⅲ.
The definitive diagnosis was made by CT, aortography, echocardiography, MRI. Among them 36 cases(70.6% ) were treated by medically, in which 3 patients were died. 15 cases(29.4% ) were treated by surgically, in which 10 patients were died.
Conclusion
Among 51 cases, no ST segment elevation in all cases was found and mediastinal widening on chest PA was found in 63%. It is thought that ECG and chest PA is very important screening method to differentiate acute myocardial infarction from dissecting aortic aneurysm, when patients suffered from acute chest pain visit emergency room.
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| Key words:
Aneurysm, dissecting, Aorta, ECG, Plain chest PA |
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