Ann Thorac Surg 2009;87:e49. doi:10.1016/j.athoracsur.2009.02.036
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Immediate Regression of Thrombosed False Lumen in Ascending Aorta of Retrograde Type A Aortic Dissection
Koichi Akutsu, MDa,*,
Shinya Yokoyama, MDa,
Noritake Hata, MDa,
Takuro Shinada, MDa,
Kyoichi Mizuno, MDb
a Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
b Division of Cardiology, Hepatology, Geriatrics, and Integrated Medicine, and Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
* Address correspondence to Dr Akutsu, Department of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inbamura, Inbagun, Chiba 270-1694, Japan (Email: koichi-a{at}nms.ac.jp).
A 56-year-old man with chest pain had a type A aortic dissection that involved the anatomic area spanning the proximal parts of the brachiocephalic trunks to a point just distal to the superior mesenteric artery, with thrombosis in the false lumen. An ulcerlike projection was observed at the proximal descending aorta, which seemed to be the initiation point of the dissection. On the sixth day after the onset of the first symptoms, the patient experienced another chest pain; and a computed tomography (CT) scan showed a newly emerged thrombosed false lumen in the ascending aorta, representing a dissection extending retrogradely from the ulcerlike projection at the proximal descending aorta to the aortic root (Fig 1; arrow indicates the ulcerlike projection). On the eighth day, a CT scan showed regression of the thrombus, and the false lumen in the ascending aorta had almost disappeared (Fig 2; arrow indicates the regressed false lumen in the ascending aorta). Follow-up CT scan on the 22nd day demonstrated significant dilation of the ulcerlike projection site, although no remarkable change was observed in the ascending aorta. The patient underwent replacement of the proximal descending aorta and was discharged in ambulatory condition on the 60th day after the onset. He is being followed up as an outpatient.
This rapid regression of a false lumen in the ascending aorta might be caused by the compression of the false lumen in the ascending aorta, resulting in the movement of the thrombus in the false lumen to the distal portion of aorta. Such phenomenon has been reported before [1]. This phenomenon demonstrates the incomplete thrombosis of the false lumen, and indicates that the "thrombus" might be actually soft and pliable. It is important to be aware that the quality of the thrombus in a false lumen may affect the patient's clinical course.
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