Study note

Pathogenesis of aortic dissection

THE CONTEXT

Aortic dissection may begin with an intimal tear or with bleeding within the aortic media.

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The primary event is often a spontaneous or iatrogenic intimal tear; multiple tears or entry points are common.

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Some dissections begin with primary haemorrhage in the media, which subsequently ruptures through the intima into the true lumen.

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Spontaneous bleeding from the vasa vasorum may remain confined to the aortic wall and present as a painful intramural haematoma.

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Aortic disease and hypertension are the most important aetiological factors.

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Chronic dissection may cause aneurysmal dilatation, while thoracic aneurysms may themselves be complicated by dissection.

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Because either process may precede the other, identifying the primary pathology can be difficult.

NEETx

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