title: Type A aortic dissection presenting as superior vena cava syndrome.
abstract: A 51-year-old man presented with a 5-day history of progressive facial swelling, sensation of head fullness, increasing shortness of breath and paroxysmal nocturnal dyspnea. He denied chest pain, syncope or presyncope. Past medical history included mechanical aortic valve replacement 7 years prior and atrial fibrillation treated with warfarin. A clinical diagnosis of acute superior vena cava (SVC) syndrome was made. Portable chest radiograph showed a widened superior mediastinum. Computed tomography scan of the thorax demonstrated a large type A aortic dissection almost completely effacing the SVC. Acute type A aortic dissection (AD) is an emergency requiring prompt diagnosis and treatment. Patients typically present with acute onset of chest and/or back pain, classically described as "ripping" or "tearing." SVC syndrome is rarely, if ever, mentioned as a presentation, as it is usually due to more chronic conditions. This case illustrates a rare incidence of type A AD actually presenting as SVC syndrome.
authors.affiliation: Department of Diagnostic Radiology, University of Western Ontario, London, ON, Canada. fraja3@uwo.ca
authors.forename: Faisal S
authors.initials: FS
authors.lastname: Raja
authors.forename: Ali
authors.initials: A
authors.lastname: Islam
authors.forename: Mustafa
authors.initials: M
authors.lastname: Khan
authors.forename: Iram
authors.initials: I
authors.lastname: Abbasi
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D003287:Contrast Media; D003937:Diagnosis, Differential; D004630:Emergencies; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D013902:Radiography, Thoracic / Q000379:methods; D018570:Risk Assessment; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
chemical_list: D003287:Contrast Media