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Diseksi aorta akut non-traumatik sebagai tantangan diagnosis klinis dalam kedaruratan: kasus serial

  • Putu Aditha Satya Putra ,
  • M. Widhiasih ,
  • P. Patriawan ,

Abstract

Aorta dissection is a complication of aortic aneurysm which is characterized as a separation of the walls of the blood-filled aorta. This condition is quite rare with an incidence rate of 2.6-3.5/100.000 patients per year, but highly fatal. The varied manifestations of this condition may cause a misdiagnosis due to the similar symptoms with other conditions. We reported 4 cases of aortic dissection for 2 years in Sanglah Hospital; a 42 years old male with a Stanford A aortic dissection and a grade 3-TAVB, a 63 years old male with aortic aneurysms with an abdominal aortic dissection and occlusion of left renal artery cause renal infarction and contracted, and two cases of a 72 and 82 years old males with an abdominal aortic dissection, one of which also has lung cancer which has metastasized to the liver. No specific symptoms of aortic dissection were present on these patients. Three of the patients died before surgical intervention. Accordance with our findings, aortic dissection is more likely in males and high mortality rate. Aortic dissection is often accompanied by other clinical conditions, thus masking its presence and causing the specific signs of aortic dissection to not appear which is clearly observed in our report. The specific symptoms were only present in 5-15% cases, leading to a misdiagnosis and delayed treatment. CT angiography, has a significant role in determining the diagnosis of aortic dissection.

 

 

Diseksi aorta merupakan komplikasi dari aneurisma aorta, yang ditandai oleh adanya pemisahan lapisan dinding aorta. Kondisi ini cukup langka dan dapat berakibat fatal, dengan angka kejadian 2,6-3,5/100.000 pasien per tahun. Manifestasi yang bervariasi dari diseksi aorta dapat menyebabkan kesalahan dalam menegakkan diagnosa, hal ini disebabkan karena gejala yang muncul dapat menyerupai penyakit lainnya. Kami melaporkan 4 kasus diseksi aorta, yang ditemukan dalam kurun waktu 2 tahun di Rumah Sakit Umum Pusat Sanglah Denpasar. Dua kasus pertama adalah lelaki berusia 42 tahun dengan diseksi aorta Stanford A, grade 3-Total arterioventricular block (TAVB), dan lelaki berusia 63 tahun dengan aneurisma aorta yang disertai diseksi aorta abdominalis dan oklusi arteri renalis kiri. Dua kasus terakhir adalah lelaki usia 72 dan 82 tahun dengan diseksi aorta abdominalis, salah satunya menderita kanker paru-paru yang telah menyebar ke hati dan tidak menunjukkan gejala spesifik dari diseksi aorta. Tiga dari empat kasus meninggal sebelum dilakukan intervensi bedah. Pada kasus kami, diseksi aorta lebih banyak terjadi pada lelaki dengan tingkat kematian yang tinggi. Diseksi aorta seringkali disertai kondisi klinis lainnya, sehingga menutupi keberadaannya dan tidak memunculkan gejala spesifiknya. Gejala spesifik yang hanya muncul pada 5-15% kasus, dapat menyebabkan kesalahan diagnosis dan keterlambatan pengobatan. Masalah ini terpapar dalam laporan kasus kami. Computed tomography (CT) angiografi memiliki peran penting dalam menentukan diagnosis.

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How to Cite

Putra, P. A. S., Widhiasih, M., & Patriawan, P. (2020). Diseksi aorta akut non-traumatik sebagai tantangan diagnosis klinis dalam kedaruratan: kasus serial. Medicina, 51(3). https://doi.org/10.15562/medicina.v51i3.790

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