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2016, vol. 38, iss. 1-2, pp. 55-58
Acute aortic dissection in patient with suspected pheochromocytoma
aUniversity of Belgrade, Faculty of Medicine, Institute of Cardiovascular Diseases 'Dedinje'
bUniversity of Belgrade, Faculty of Medicine, Institute of Cardiovascular Diseases 'Dedinje' + University of Belgrade, Faculty of Medicine

emailmiss.sagic@gmail.com
Abstract
Introduction: Aortic dissection is one of the most fatal vascular emergencies. Almost 40% of the patients do not reach hospital in time while more than quarter die in the first 24 hours after the dissection begins. Case Report: A 37-year old man was admitted to our hospital with severe anterior chest pain which had lasted for over a week. Suspected aortic dissection was rapidly confirmed using imaging modalities - MDCT chest scan and TTE, followed by an urgent surgical management - Bentall procedure. MDCT chest scan also discovered adrenal incidentaloma defined as malignant, pheochromocytoma like mass. Due to the critical state of the patient, there was not enough time for further endocrinologic testing. Discussion and conclusion: When treating patients with pheochromocytoma and acute aortic disection, it is crucial to obtain a stable hemodynamic state before the surgery, since they can trigger a severe hypertensive crisis due to high levels of cathecholamines induced chronic vasoconctriction. The most vulnerable periods are the induction of anesthesia and perioperative hemodynamic oscillations, so treating patients with short acting alpha- 1 adrenergic blocking agents preoperatively has proven to be helpful - Phentolamine. Both dissection of aorta and pheochromocytoma present challenges for anesthesiologists and early recognition of symptoms is essential in establishing the diagnosis and reducing the mortality rate.
References
Augoustides, J.G., Pantin, E.J., Cheung, A.T. (2011) Thoracic Aorta. in: Kaplan's Cardiac Anesthesia: The Echo Era, Missouri: Saunders, Elsevier Inc, str. 637-674
Därr, R., Lenders, J.W.M., Hofbauer, L.C., Naumann, B., Bornstein, S.R., Eisenhofer, G. (2012) Pheochromocytoma - update on disease management. Therapeutic advances in endocrinology and metabolism, 3(1): 11-26
Domi, R., Laho, H. (2012) Management of pheochromocytoma: Old ideas and new drugs. Nigerian Journal of Clinical Practice, 15(3): 253
Kota, S., Kota, S., Meher, L., Jammula, S., Panda, S., Modi, K. (2012) Coexistence of pheochromocytoma with uncommon vascular lesions. Indian Journal of Endocrinology and Metabolism, 16(6): 962
Matadial, C., Giquel, J., Martinez-Ruiz, R. (2013) Concomitant elective resection of pheochromocytoma and repair of aortic abdominal aneurysm. JRSM Cardiovascular Disease, 2: 1-4
Myklejord, D.J. (2004) Undiagnosed Pheochromocytoma: The Anesthesiologist Nightmare. Clinical Medicine & Research, 2(1): 59-62
Zheng, S., Sun, Y., Meng, X., Zhang, H., Hou, X., Wang, J., Gao, F. (2005) Surgical management for Stanford A aortic dissection. Zhonghua wai ke za zhi [Chinese journal of surgery], 43(18): 1177-80
 

About

article language: Serbian
document type: Case Report
DOI: 10.5937/sjait1602055L
published in SCIndeks: 12/08/2016
Creative Commons License 4.0

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