title: A case of acute type B aortic dissection: limited role of laboratory testing for the diagnosis of mesenteric ischemia.
abstract: A 30-year-old man with severe back and abdominal pain was referred to our hospital because of a recurrence of acute type B aortic dissection. A computed tomography scan showed a 3-channel dissection and a severe narrowing of the true lumen of the descending aorta to the abdominal aorta because of the expansion of the newly formed second false lumen. Although laboratory testing, including creatine phosphokinase, lactate dehydrogenase, and lactate levels, indicated no visceral ischemia, abdominal pain requiring narcotics treatment had to be continued for more than 1 week. Based on the symptoms and computed tomography findings, the patient finally underwent aortic replacement, fenestration, and a reconstruction of the inferior mesenteric artery, after which the abdominal pain disappeared. Operative findings confirmed a pale shrunken intestine, indicative of mesenteric ischemia. The present case is a good demonstration revealing that mesenteric ischemia still remains a diagnostic challenge, and suggests that currently available laboratory markers are not sensitive enough to detect the presence of ischemia. A strong clinical suspicion for mesenteric ischemia may be the only key to preventing a catastrophic outcome in this condition.
authors.affiliation: Department of Cardiovascular Medicine, National Cardiovascular Center, Suita, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Akutsu
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sasaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Minatoya
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ogino
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kasai
authors.forename: Yuiichi
authors.initials: Y
authors.lastname: Tamori
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yokoyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonogi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takeshita
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D015415:Biomarkers / Q000032:analysis; D003937:Diagnosis, Differential; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D008297:Male; D008643:Mesentery / Q000098:blood supply*; D012008:Recurrence; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers