Acute Type A Aortic Dissection Diagnosed by POCUS in a 29-year-old Man
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ABSTRACT:
SUBMITTER: Cardenas Lopez V
PROVIDER: S-EPMC10700150 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:IntroductionSarcoma as a cause of laryngeal cancer is rare and is even rarer to have an Ewing sarcoma out of the bone presents as laryngeal cancer. In this report, we present this extremely rare case.Case presentationA 41-year-old man was seen at the ENT clinic complaining of chronic hoarseness and a lump in his neck. Flexible laryngoscopy showed a large mass occupying the left side of the larynx and then a computerized tomography scan proved it. For further evaluation, the laryngoscopy was performed and the frozen section revealed a malignancy. Consequently, the surgical decision was taken and a total Laryngectomy and thyroidectomy were carried out. A final diagnosis of Ewing sarcoma was established using histological examination and immunohistochemical staining. The patient was referred for adjuvant chemo-radiotherapy as recommended by the oncology service.Clinical discussionlaryngeal cancer is rarely diagnosed as Ewing sarcoma. The defined diagnosis should be made based on histological study and immunohistochemical staining besides the clinical presentation and other examinations. Our patient was a candidate for surgical treatment and negative surgical margins were achieved. He was referred for adjuvant chemo-radiotherapy as some studies demonstrated the efficacy of multimodal therapy in treating Ewing sarcoma.ConclusionBecause of the lack of similar studies and documented data in the medical literature about this rare case, Ewing sarcoma should be included in the differential diagnosis in laryngeal cancer cases.
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Project description:ObjectiveTo assess outcomes of endovascular reperfusion followed by delayed open aortic repair for stable patients with acute type A aortic dissection and mesenteric malperfusion syndrome (mesMPS).MethodsAmong 602 patients with acute type A aortic dissection who presented to our center from 1996 to 2017, all 82 (14%) with mesMPS underwent upfront endovascular fenestration/stenting. Primary outcomes were in-hospital mortality and long-term survival. Patients with acute type A aortic dissection with no malperfusion syndrome of any organ (n = 419) served as controls.ResultsIn-hospital mortality of all comers with mesMPS was 39%. After endovascular fenestration/stenting, 20 mesMPS patients (24%) died from organ failure and 11 patients (13%) died from aortic rupture before open aortic repair, 47 patients (58%) underwent aortic repair, and 4 patients (5%) survived without open repair. No patients died from aortic rupture during the second decade (2008-2017). The significant risk factors for death from organ failure after endovascular reperfusion were acute stroke (odds ratio, 23; 95% confidence interval, 4-144; P = .0008), gross bowel necrosis at laparotomy (odds ratio, 7; 95% confidence interval, 1.4-34; P = .016), and serum lactate ≥6 mmol/L (odds ratio, 13.5; 95% confidence interval, 2-97; P = .0097). There was no significant difference in operative mortality (2.1% vs 7.5%; P = .50) or long-term survival between patients with mesMPS who underwent open aortic repair after recovering from mesMPS and patients with no malperfusion syndrome.ConclusionsIn patients with acute type A aortic dissection with mesMPS, endovascular fenestration/stenting, and delayed open aortic repair achieved favorable short- and long-term outcomes. Surgeons should consider correcting mesenteric malperfusion before undertaking open aortic repair in patients with mesMPS, especially those with acute stroke, gross bowel necrosis at laparotomy, or serum lactate ≥6 mmol/L.
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