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Case report
peer-reviewed

Cocaine-induced Type-A Aortic Dissection Extending to the Common Iliac Arteries



Abstract

Aortic dissection is a rare and fatal complication of cocaine-induced hypertension. The injury mechanism is through shear stress that penetrates the intimal vessel layer, allowing blood flow to separate intimal and medial layers. Due to its scarcity and the paucity of related literature, our knowledge of this condition is limited. We present a rare case of a cocaine-induced aortic dissection, which extended continuously from the aortic root to the common iliacs, along with a literature review of similar cases.

A 48-year-old male with recent cocaine use presented with left-sided chest-pain, which radiated to the back with nausea, diaphoresis, and shortness of breath. The patient was hypotensive. The initial radiographs and computed tomography were negative. The cardiac enzymes were elevated and the patient was admitted to rule out acute coronary syndrome. Next day echocardiogram and computed tomography revealed a Type-A aortic dissection continuously extending from the aortic root to the left common iliac artery. The patient was immediately transferred for surgery. Postoperatively, he developed acute kidney injury and shock liver. The patient status continued to deteriorate and he expired on postoperative day four.

This case demonstrates the importance of prompt and thorough diagnostic evaluation, despite subjective history and initially negative imaging that might point towards other conditions. Unlike the previous cases, our case failed to identify the positive history of cocaine until nearly 24 hours into the patient’s hospital course, suggesting a need for close monitoring in these patients and a possible need for repeat imaging.​​​​​​​



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Case report
peer-reviewed

Cocaine-induced Type-A Aortic Dissection Extending to the Common Iliac Arteries


Author Information

Mohamed A. Mohamed Corresponding Author

College of Human Medicine, Michigan State University

Rohit Abraham

College of Human Medicine, Michigan State University College of Human Medicine

Tareq I. Maraqa

Trauma Department, Hurley Medical Center, Michigan State University

Samir Elian

Cardiology, Hurley Medical Center


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Cocaine-induced Type-A Aortic Dissection Extending to the Common Iliac Arteries


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Case report
peer-reviewed

Cocaine-induced Type-A Aortic Dissection Extending to the Common Iliac Arteries

  • Author Information
    Mohamed A. Mohamed Corresponding Author

    College of Human Medicine, Michigan State University

    Rohit Abraham

    College of Human Medicine, Michigan State University College of Human Medicine

    Tareq I. Maraqa

    Trauma Department, Hurley Medical Center, Michigan State University

    Samir Elian

    Cardiology, Hurley Medical Center


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: January 12, 2018

    DOI

    10.7759/cureus.2059

    Cite this article as:

    Mohamed M A, Abraham R, Maraqa T I, et al. (January 12, 2018) Cocaine-induced Type-A Aortic Dissection Extending to the Common Iliac Arteries. Cureus 10(1): e2059. doi:10.7759/cureus.2059

    Publication history

    Received by Cureus: December 09, 2017
    Peer review began: December 16, 2017
    Peer review concluded: January 09, 2018
    Published: January 12, 2018

    Copyright

    © Copyright 2018
    Mohamed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Aortic dissection is a rare and fatal complication of cocaine-induced hypertension. The injury mechanism is through shear stress that penetrates the intimal vessel layer, allowing blood flow to separate intimal and medial layers. Due to its scarcity and the paucity of related literature, our knowledge of this condition is limited. We present a rare case of a cocaine-induced aortic dissection, which extended continuously from the aortic root to the common iliacs, along with a literature review of similar cases.

A 48-year-old male with recent cocaine use presented with left-sided chest-pain, which radiated to the back with nausea, diaphoresis, and shortness of breath. The patient was hypotensive. The initial radiographs and computed tomography were negative. The cardiac enzymes were elevated and the patient was admitted to rule out acute coronary syndrome. Next day echocardiogram and computed tomography revealed a Type-A aortic dissection continuously extending from the aortic root to the left common iliac artery. The patient was immediately transferred for surgery. Postoperatively, he developed acute kidney injury and shock liver. The patient status continued to deteriorate and he expired on postoperative day four.

This case demonstrates the importance of prompt and thorough diagnostic evaluation, despite subjective history and initially negative imaging that might point towards other conditions. Unlike the previous cases, our case failed to identify the positive history of cocaine until nearly 24 hours into the patient’s hospital course, suggesting a need for close monitoring in these patients and a possible need for repeat imaging.​​​​​​​



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Create a free account to continue reading this article.

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Mohamed A. Mohamed

College of Human Medicine, Michigan State University

For correspondence:
mohame57@msu.edu

Rohit Abraham

College of Human Medicine, Michigan State University College of Human Medicine

Tareq I. Maraqa, M.D., Fellow Physician

Trauma Department, Hurley Medical Center, Michigan State University

Samir Elian

Cardiology, Hurley Medical Center

Mohamed A. Mohamed

College of Human Medicine, Michigan State University

For correspondence:
mohame57@msu.edu

Rohit Abraham

College of Human Medicine, Michigan State University College of Human Medicine

Tareq I. Maraqa, M.D., Fellow Physician

Trauma Department, Hurley Medical Center, Michigan State University

Samir Elian

Cardiology, Hurley Medical Center