Acute aortic dissection in a patient receiving gemcitabine and cisplatin.
Acute aortic dissection is often a fatal condition with in-hospital mortality rates of 27%. The incidence of acute aortic dissection is low at around 3 cases per 100,000 person-years. There is a strong relationship between hypertension and aortic dissection. 72% of patients in the International Registry of Acute Aortic Dissection had a history of hypertension. The inciting event is an intimal tear extending into the media with resultant dissection of blood along the laminar planes of the media. Cisplatin, a commonly used platinum-based chemotherapy drug, is associated with the development of hypertension on long-term follow up studies. This knowledge should prompt clinicians to screen for the development of hypertension and to be aware of its potential complications in patients treated with cisplatin-containing chemotherapy. Despite the known vascular complications of chemotherapy, there is a paucity of data on the association of aortic dissection with active cancer or chemotherapy. We present an unusual case of an extensive, acute aortic dissection in a relatively young male patient receiving gemcitabine and cisplatin for advanced metastatic pancreatic adenocarcinoma.
Department of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, OK.
George W
GW
Madden
Muhammad K
MK
Ishaq
Raghav
R
Gupta
D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy; D000328:Adult; D000784:Aortic Dissection / Q000139:chemically induced* / Q000473:pathology; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology; D001014:Aortic Aneurysm / Q000139:chemically induced* / Q000473:pathology; D000069287:Capecitabine; D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017809:Fatal Outcome; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000473:pathology; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000150:complications / Q000188:drug therapy; D010996:Pleural Effusion / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D003841:Deoxycytidine; D000069287:Capecitabine; D002945:Cisplatin; D005472:Fluorouracil; D000093542:Gemcitabine