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A dissecting aortic aneurysm involving a right-sided aortic arch Kazuko Horie 1 , Minoru Usui 1 , Toshihiko Kato 1 , Tetsuo Asano 2 , Yaoki Mizuno 2 , Kunihiko Hiei 2 1Department of Cardiovascular Medicine, Gifu Red Cross Hospital 2Department of Internal Medicine, Ibi General Hospital pp.107-111
Published Date 1989/1/15
DOI https://doi.org/10.11477/mf.1404205413
  • Abstract
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A 51-year-old woman suddenly developed severe pain in the chest and back, and also dyspnea. On admission, she was in a state of preshock. Plain X-ray indicated the lack of the left aortic arch and poor pneumatization in the whole right lung. The thoracic fluid was transparent with yellowish tinge and was contaminated with neither any bacterium nor tubercle bacillus. The response to the Rivalta's reaction was negative. The possibility of pleurisy was, therefore, denied. The ECG and blood bioch-emical data on the second day suggested the pos-sibility of myocardial ischemia.

Plain chest X-ray on the fourth day revealed an increased right pulmonary pneumatization and an enlarged mediastinal shadow toward the aortic arch. Upper pulmonary CT showed a mass on the right side. Enhanced CT disclosed a dissepiment in the center, which was high medially and somewhat lowlaterally. It was diagnosed as a false lumen due to the lateral displacement of the right aortic arch. Hepatic CT disclosed the tapering of the abdominal aorta from right to left in the prevertebral region. These findings indicated that the aorta descended from the right aortic arch along the right side of the spine and crossed the spine dextrosinistrally at the heptic level.In addition, dissociant aneurysm was observed in the right aortic arch. Echocardiography showed no evidence of dissociant aneurysm at the aortic base. Chest X-ray, CT and echocardiography showed the dissociation of the aorta from the aortic arch to the abdominal aorta. Thus the diagnosis of De Bakey type was established. Clinically, DIC and multiorgan disorders were manifested but after medical treatments, the clinical course was une-ventful.

The incidence of right-sided aortic arch is gener-ally estimated to be approximately 0.1%. There are two major anatomical types of right-sided aortic arch. One is a mirror image diametrical to the normal, having three vessels from the aortic origin. Cyanotic congenital heart diseases may occur in most patients with this type. The other is the most common type with four vessels from the aortic base. The present case seems to belong to the lat-ter type.

Dissociant aneurysm involving the right-sided aortic arch is extremely rare. To the best of our knowedge, this is the fifth reported in the whole world and the second in Japan.


Copyright © 1989, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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