A 66-year-old male with a history of hypertension presents to the emergency department with dyspnea and sharp abdominal pain radiating to his back. On examination, his blood pressure is 180/120 mm Hg. A CT scan demonstrates the findings seen here and laboratory testing indicates that his renal function is preserved.
Image credit: @radioactive9.
Answer: Antihypertensive therapy
This patient’s presentation and imaging findings are suggestive of aortic dissection, a tear in the intimal layer of the aorta resulting in a true and false lumen. This dissection is classified as a type B according to the widely used Stanford system, as it is confined to the descending aorta. Patients with a type B dissection who are hemodynamically stable may be managed medically with antihypertensive therapy and serial imaging. Indications for surgery include persistent hypertension or pain, or occlusion of a major aortic branch leading to end-organ ischemia. Acute type A dissections, which involve the ascending aorta, are considered surgical emergencies.
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