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A 72-year-old man presented with a 5-week history of exertional dyspnoea and facial
swelling on a background of hypertension and previous coronary artery bypass graft
(CABG) surgery for acute coronary syndrome (left internal mammary artery to left anterior
descending/third diagonal branch and left radial artery to first obtuse marginal)
5 years prior. He denied any facial pain, headache or arm swelling. He was lost to
follow-up following his coronary artery bypass graft (CABG) surgery. On clinical examination,
the heart rate was 70 bpm and blood pressure was 160/90 mmHg. The patient was noted
to be plethoric, with facial swelling and distended external jugular veins (Figure 1A). Carotid pulse was of normal character and without bruits. His heart sounds were
dual with no added sounds or murmurs. Auscultation of his lungs did not reveal any
abnormalities and there was no peripheral oedema.
Figure 1(A) Distended external jugular vein. (B) Chest X-ray demonstrating a widened mediastinum.
(C) Transthoracic echocardiogram demonstrating a dilated ascending aorta measuring
8.1 cm. (D) Sagittal view of the aorta revealing a pseudoaneurysm compressing the
superior vena cava (green arrows). (E) Multiplanar reconstruction showing the aortic
dissection (yellow arrows). (F&G) 3-dimensional multiplanar computed tomography reconstruction
demonstrating circumferential aortic dissection extending from the proximal ascending
aorta to aortic arch (blue arrows).
Akute Dissektion der Aorta ascendens Typ A nach aortokoronarer bypass-operation [acute type A dissection of the ascending aorta after aortocoronary bypass operation].
Sindrom gornje suplje vene kao manifestacija disekcije ascendentne aorte [The superior vena cava syndrome as a manifestation of dissection of the ascending aorta].
