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