doiSerbia

Acute renal failure and hepatocellular damage as presenting symptoms of type II aortic dissection

Jovanović Ivana (Clinical Center of Serbia, Clinic for Cardiology, Belgrade)
Tešić Milorad (Clinical Center of Serbia, Clinic for Cardiology, Belgrade)
Antonijević Nebojša (Clinical Center of Serbia, Clinic for Cardiology, Belgrade + School of Medicine, Belgrade)
Menković Nemanja (Clinical Center of Serbia, Centre for Radiology and Magnetic Resonance, Belgrade)
Paunović Ivana (Clinical Center of Serbia, Clinic for Cardiology, Belgrade)
Ristić Arsen (Clinical Center of Serbia, Clinic for Cardiology, Belgrade + School of Medicine, Belgrade)
Vučićević Vera (Clinical Center of Serbia, Center for Anesthesiology and Reanimatology, Belgrade)
Vujisić-Tešić Bosiljka (Clinical Center of Serbia, Clinic for Cardiology, Belgrade + School of Medicine, Belgrade)

Introduction. Pericardial effusion can be a consequence of a number of pathological conditions, and as such it can cause impaired left ventricular filling followed by decreased cardiac output and blood pressure. This kind of hemodynamic compromise and its consequences are extremely uncommon unless pericardial effusion causes tamponade. Case Outline. We describe a very rare case of a 30-year old male patient, with an acute aortic dissection type II causing pericardial effusion without clinical nor echocardiographic signs of tamponade, while presenting with an acute renal and hepatic failure. After initial diagnostic uncertainties, and following final diagnosis of an acute aortic dissection, this patient underwent surgical aortic valve replacement with a satisfactory outcome. Conclusion. It is important to underscore the significance of clinical situation of simultaneously existing acute renal and hepatic failures in the setting of a “non-tamponade” pericardial effusion, following a type II aortic dissection. Although most commonly aortic dissection presents itself with typical clinical symptoms or patient history data, it is not that unusual for it to be hidden in an entirely atypical clinical milieu as the one described in this case.

Keywords: aortic dissection, intimal flap, renal failure, hepatic failure, pericardial effusion