title: Occult rhabdomyolysis after acute type A aortic dissection.
abstract: OBJECTIVE
  We report a case of a patient presenting with an acute type A aortic dissection who presented with bilateral lower extremity paraplegia and development of rhabdomyolysis of the paraspinal muscles during the postoperative period. This discussion includes presentation, clinical course, diagnosis, and management of this rare complication.
  
  
  METHODS
  Data were collected from the patient's electronic medical record and the hospital radiology database.
  
  
  CONCLUSIONS
  Our case describes rhabdomyolysis of the paraspinal muscles occurring after acute type A aortic dissection. Lumbar arteries that supply the paraspinal muscles may become compromised because of either hypoperfusion or occlusion from aortic cross-clamping, or ligation of the vessels within the false lumen of the dissection, or from atheroembolic phenomena. The resultant ischemia causes edema and necrosis of the paraspinal muscles, subsequently increasing the pressure within the paraspinal compartment. Treatment includes fluid administration, urine alkalinization, and monitoring for signs of acute renal failure.
authors: Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA. anthond@ccf.org
authors: David G
authors: DG
authors: Anthony
authors: James
authors: J
authors: Diaz
authors: C
authors: C
authors: Allen Bashour
authors: Doksu
authors: D
authors: Moon
authors: Edward
authors: E
authors: Soltesz
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D010264:Paraplegia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011859:Radiography; D012206:Rhabdomyolysis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D056346:Sternotomy / Q000379:methods; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods