aortic dissection

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심한 복통 또는 chest pain(sharp or stabbing or as a tearing).

특징적으로 박동성 통증(pulsatile pain.) 

보통 진통제,진경제로 조절되지 않는 복통으로 오며, radiating back pain, flank pain을 호소하기도 한다.

Low blood pressure; high suspicion when there's a 20 mmHg pressure difference between arms.

 

 

상행 하행이 포인트.

 

Acute type A aortic dissection (AAD) is a life-threatening emergency that carries a high mortality rate without surgical treatment . Surgical mortality has been estimated to range from 9% to 30%, and survival rates of 51–82% at 5 years have been reported.

 

상행은 흉부외과 emergent open surgery indication.  바로 상급병원 연락해서 전원.

 

type B의 경우 일단 BB IV로 주입. (labetalol, 라베신주사) 

 

Beta blockers are often the first treatment for a type B aortic dissection. These medications reduce blood pressure by blocking the effects of the hormone epinephrine, or adrenaline. This relaxes the heart, slowing it down. Less blood leaves the heart, and it leaves with less force.

 

chest CT - type A

chest CT - type B

CXR

CXR에서 mediastinal widening, aortic notch를 잘 봐야한다.