Published online Jun 6, 2022. doi: 10.12998/wjcc.v10.i16.5394
Peer-review started: September 10, 2021
First decision: January 10, 2022
Revised: January 19, 2022
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: June 6, 2022
Processing time: 264 Days and 16.9 Hours
Aortic dissection (AD) and pulmonary embolism (PE) are both life-threatening disorders. Because of their conflicting treatments, treatment becomes difficult when they occur together, and there is no standard treatment protocol.
A 67-year-old man fell down the stairs due to syncope and was brought to our hospital as a confused and irritable patient who was uncooperative during the physical examination. Further examination of the head, chest and abdomen by computed tomography revealed a subdural hemorrhage, multiple rib fractures, a hemopneumothorax and a renal hematoma. He was admitted to the Emergency Intensive Care Unit and given a combination of oxygen therapy, external rib fixation, analgesia and enteral nutrition. The patient regained consciousness after 2 wk but complained of abdominal pain and dyspnea with an arterial partial pressure of oxygen of 8.66 kPa. Computed tomography angiograms confirmed that he had both AD and PE. We subsequently performed only nonsurgical treatment, including nasal high-flow oxygen therapy, nonsteroidal analgesia, amlodipine for blood pressure control, beta-blockers for heart rate control. Eight weeks after admission, the patient improved and was discharged from the hospital.
Patients with AD should be alerted to the possibility of a combined PE, the development of which may be associated with aortic compression. In patients with type B AD combined with low-risk PE, a nonsurgical, nonanticoagulant treatment regimen may be feasible.
Core Tip: Here we show a case of a patient with multiple injuries from a fall who was admitted 2 wk later and found to have a concurrent type B aortic dissection, and low-risk pulmonary embolism. We determined that the thrombosis was probably related to compression of the aortic hematoma. After 6 wk of nasal high-flow oxygen therapy, analgesia, slowing of heart rate, lowering of blood pressure, and non-anticoagulation, the patient was discharged. This case shows us that non-surgical non-anticoagulation may be appropriate for patients with aortic dissection combined with low-risk pulmonary embolism.