A case report: Acute presentation of chronic aortic dissection

Chronic aortic dissection is a rare variant of aortic dissection where dissection in a weakened aortic wall and subsequent blood flow occur over a period of 3 months or more. The underlying mechanism for chronicity and global burden of the disease is not well documented or understood. Further contributed by the overall rarity of aortic dissection, literature published on the topic is lacking. We present a case of a 83-year-old lady who presented with features of Cor Pulmonale with coexisting right hypochondrium tenderness which when further evaluated with a USG revealed an aortic aneurysm with features of dissection. Further evaluation with a CT scan revealed a Stanford type A, DeBakey type I aortic dissection with a false flap and calcific changes hinting to its chronic nature. The patient was managed for the presenting features and is under regular outpatient care for aortic dissection. Among the survivors of acute dissection/aneurysms people in their 6th and 7th decade and having a history of familial disease, dyslipidemia, arterial hypertension and aortic surgeries seem to be at higher risk of chronic dissection. Although more common in males, females seem to have worse prognosis. Various imaging modalities may be useful in diagnosis, CT being the most reliable. Intimal tears and flaps showing flow in the false lumen and calcification of the aortic wall are some positive radiological findings. Thrombus formation in the slow blood flowing false lumen with subsequent embolisation, secondary aneurysms and rupture, end organ malperfusion, pericardial tamponade may be some dreaded complications. These may be avoided by timely diagnosis and intervention that may extend the life expectancy by as much as 7 years. Chronic Aortic dissection is a rare and complicated entity that is not well understood. Various complications of the disease may be the cause of severe morbidity and mortality. Timely diagnosis and interventions such as aortic repair and/ or active surveillance are essential for a positive outcome.