title: Ascending aortic dissection without intimal tear: a case report.
abstract: Aortic dissection may occur without the presence of intimal tear, and it may occur with medial dissection and intramural hematoma. We report a case in which mediastinal enlargement was found in the chest x-ray of a 79-year-old patient with chest and back pain that had started suddenly 1 week before. The patient had a decrease in hematocrit, and transthoracic echocardiography revealed around the heart pericardial fluid 5 cm thick. The ascending aorta could not be evaluated because of the presence of this fluid. The preoperative diagnosis, based on the computerized tomography findings (dissection of ascending aorta and pericardial fluid), was ruptured dissection of the ascending aorta. The patient underwent an emergency operation. Two liters of hemorrhagic fluid was aspirated from the pericardium during the operation. The ascending aorta was opened, but there was no intimal tear. Medial dissection and intramural hemorrhage were seen. The ascending aorta was replaced with a tube graft. Cases such as this, of medial dissection and intramural hematoma in which intimal integrity is preserved, should be approached in the same manner as classical dissections with intimal tear.
authors.affiliation: Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, 67 Ada Kardelen 4-4, D:11 Atasehir, 81120 Istanbul, Turkey. mehmetkaplan@superonline.com
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kaplan
authors.forename: Fikri
authors.initials: F
authors.lastname: Yapici
authors.forename: Murat
authors.initials: M
authors.lastname: Erkan
authors.forename: Murat
authors.initials: M
authors.lastname: Sargin
authors.forename: Mahmut Murat
authors.initials: MM
authors.lastname: Demirtas
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D011859:Radiography; D017539:Tunica Intima / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery