Extensive Acute Aortic Intramural Hematoma: Rare Complication Following Cardiopulmonary Resuscitation
Suleiman Sudah, B.S, Khanjan Nagarsheth, M.D, M.B.A, R.P.V.I.
Rutgers University - Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Objectives: Cardiopulmonary resuscitation (CPR) is a lifesaving procedure used to establish return of spontaneous circulation (ROSC) following cardiac arrest. Herein, we present a rare complication of aortic intramural hematoma (IMH) following CPR.
Methods: Case report and review of the literature.
Results: A 76-year-old male arrived to the emergency department with complaints of garbled speech, altered mental status, and facial droop. He was found to have an acute fronto-parietal stroke and was managed with blood pressure control and intensive care admission. Within the next few hours, he deteriorated clinically and became progressively hypoxic, resulting in cardiac arrest. He underwent several rounds of CPR and had ROSC. Subsequent to this, it was noted that he had a significant pulse differential in his lower extremities, and a CT angiogram (CTA) was ordered, which revealed an extensive IMH from the mid descending thoracic aorta to beyond the level of the renal vessels. His overall prognosis was grim, so no revascularization was performed, and his IMH was managed medically with blood pressure and heart rate control. He succumbed two days later to complications associated with his stroke and aspiration pneumonitis.
In cases of CPR-induced IMH, patients presented with symptoms of chest and back pain, aortic insufficiency, or pulse differential of the lower extremities. The diagnosis was confirmed with CT angiogram. Management ranged from conservative measures of blood pressure control to endovascular stent graft placement.
Conclusions: Following CPR, if a patient experiences chest and back pain, visceral malperfusion or lower extremity ischemia, the differential diagnosis should include aortic IMH. A CT angiogram is a reasonable diagnostic tool to identify this potentially catastrophic complication of cardiopulmonary resuscitation.
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