AKUT PULMONER EMBOLİ İLE TİP B AORT DİSEKSİYONUNUN NADİR BİRLİKTELİĞİ

Amaç: Pulmoner emboli ve aort diseksiyonu belirti ve bulguları birbirine benzer, ve her iki durumda da mortalite yüksektir. Birlikte tanısı nadirdir ve tanı alması durumunda tedavi açısından ikilem yaratır. Her iki tanıda da bilgisayarlı tomografi en çok kullanılan görüntüleme yöntemidir, acil hekimleri için yatak başı ultrason görüntülemesi de tanıda oldukça faydalıdır. Olgumuz pulmoner emboli ve aort diseksiyonu birlikteliği olan 87 yaşında erkek hastadır. Olgu Sunumu: Seksen yedi yaşında erkek hasta konuşma bozukluğu ve bilinç durum değişikliği ile acil servisimize başvurdu. Hipertansiyon, koroner arter hastalığı ve diabetes mellitus özgeçmişi mevcut idi. Hastanın ilk başvuru vital ölçümleri hipotansif ve taşikardik idi. Akciğer grafisinde aort topuzunda belirginleşme ve özefagus ve trakeasında sağa deviyasyon mevcut idi. Yatak başı ultrason görüntülemesinde her iki alt femoral venlerde komprese edilemeyen trombus ile uyumlu görünüm ve EKO’ da kalbin sağ boşlularında dilatasyon ve aort çıkımında genişleme görüldü. Çekilen bilgisayarlı tomografi anjiosunda aort çıışında anevrizmatik dilatasyon ve inen aortada diseskiyon yanı sıra sol ana pulmoner arter ve segmenter dallarda trombus saptandı. Sonuç: Acil servise başvuran hastalarda farklı tanıların bir arada görülebileceği akılda tutulmalı ve hastada kliniği açıklayan bir tanı konulsa bile altta yatan ikinci bir tanının varlığı göz ardı edilmemelidir.

Rare Coexistence of Acute Pulmonary Embolism and Type B Aortic Dissection

Aim: Signs and symptoms of pulmonary embolism and aortic dissection are similar, and mortality is high in both cases. Co-diagnosis is rare and, if diagnosed, creates a treatment dilemma. Computed tomography is the most used imaging method in both diagnoses, and bedside ultrasound imaging is also very useful for emergency physicians. Our case is an 87-year-old male patient with pulmonary embolism and aortic dissection. Case Report: An 87-year-old male patient was admitted to our emergency department with speech impairment and ab altered state of consciousness. The patient had a history of hypertension, coronary artery disease, and diabetes mellitus. The patient's initial vital measurements were hypotensive and tachycardic. Chest radiography showed prominence in the aorta and deviation to the right in the esophagus and trachea. Appearance compatible with uncompressible thrombus in both lower femoral veins on bedside ultrasound imaging and ECHO showed dilatation in the right chambers of the heart and enlargement in the aortic outlet. Computed tomography angiography revealed aneurysmatic dilatation at the outlet of the aorta and dissection in the descending aorta, as well as a thrombus in the left main pulmonary artery and segmental branches. Conclusion: It should be kept in mind that different diagnoses can be seen together in patients admitted to the emergency department. Even if a diagnosis explaining the clinic is made in the patient, the presence of a second underlying diagnosis should not be ignored.

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