Chronic DeBakey Type IIIB Aortic Dissection Presenting Acutely: A Diagnostic and Surgical Challenge in an Elderly Hypertensive Patient

TL;DR

An elderly woman with chronic aortic dissection presented acutely with severe pain and required urgent surgery, highlighting the challenges in diagnosing and treating such cases.

Contribution

This case study presents a rare instance of a chronic DeBakey type IIIB dissection presenting acutely and emphasizes the importance of comprehensive imaging for timely intervention.

Findings

Chronic aortic dissection can present acutely with severe symptoms requiring emergent surgery.

Relying solely on aortic diameter for risk assessment may be insufficient in complex dissections.

Comprehensive imaging is crucial for diagnosing and managing complicated aortic dissections.

Abstract

Aortic dissection is a rare but life-threatening condition requiring prompt diagnosis and intervention. We report the case of a 74-year-old woman with a history of long-standing hypertension who presented with sudden-onset tearing abdominal and lower back pain. Initial evaluation revealed hypotension, diminished femoral pulses, and a diastolic murmur, raising suspicion for acute aortic pathology. Imaging confirmed a chronic DeBakey type IIIB (Stanford type B) aortic dissection extending from the left subclavian artery to the iliac arteries, associated with aneurysmal dilation, a saccular pseudoaneurysm, extensive atheromatosis, and signs of malperfusion. Emergent surgical repair with a multi-branched aortic graft and valve-sparing aortic root replacement was successfully performed. This case highlights the diagnostic challenges posed by chronic dissections presenting acutely, the limitations of relying solely on aortic diameter for risk assessment, and the critical importance of early recognition and comprehensive imaging in guiding timely, life-saving interventions.

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