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Type A aortic dissection presenting as superior vena cava syndrome

Published online by Cambridge University Press:  04 March 2015

Faisal S. Raja ,
Ali Islam ,
Mustafa Khan  and
Iram Abbasi
Faisal S. Raja*
Affiliation:
Department of Diagnostic Radiology, University of Western Ontario, London, ON
Ali Islam
Affiliation:
Department of Medical Imaging, University of Western Ontario, Department of Diagnostic Radiology, Cardiac Imaging, St. Joseph's Health Care, London, ON
Mustafa Khan
Affiliation:
Department of Diagnostic Radiology, Lakeridge Health–Oshawa Department, Oshawa, ON
Iram Abbasi
Affiliation:
private practice, London, ON
*
Department of Diagnostic Radiology, St. Joseph's Hospital, 268 Grosvenor Street, PO Box 5777, London, ON N6A 5A5; fraja3@uwo.ca

Abstract

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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. Pastmedical 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.

Keywords

aortic dissectionaortic valve replacementcardiac surgerycomputed tomographysuperior vena cava syndrome
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 1 , January 2013 , pp. 59 - 62
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

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