1.1 Patient profile
The patient was a 60-year-old man with hypertension and diabetes who was transported by ambulance to our hospital’s emergency 2 hours after onset of sudden back and abdominal pain. On admission, the patient’s blood pressure was 90/66 mmHg, and palpation revealed abdominal tenderness. Cardiac ultrasonography revealed preserved left ventricular wall motion, mild aortic insufficiency, and massive pericardial effusion. Contrast-enhanced computed tomography (CT) revealed a primary entry tear in the ascending aorta, pericardial effusion, a patent false lumen and narrowed true lumen in the descending aorta, obstruction of the proximal celiac artery and superior mesenteric artery (SMA), and dissection extending into the right external iliac artery (Figure 1). Arterial blood gas analysis revealed metabolic acidosis (pH 7.22), and the blood lactate level was increased to 7.46 mmol/L. ATAAD (DeBakey type I) with cardiac tamponade and mesenteric malperfusion was diagnosed