SURGICAL MANAGEMENT OF TYPE B AORTIC DISSECTION AND PHEOCHROMOCYTOMA

Abstract

Arterial hypertension is the most important risk factor for aortic dissection. Arterial hypertension has been found in approximately 80% of aortic dissection patients. Typically, arterial hypertension is long-standing and poorly regulated in aortic dissection patients. A pheochromocytoma is a rare, catecholamine-secreting tumour that may precipitate life-threatening hypertension. The tumour is malignant in 10% of cases but may be cured completely by surgical removal. We present the case of a 49-year-old patient, heavy smoker, hypertensive, who addressed the hospital in the context of acute interscapulovertebral pain (November 2014). After a contrast agent CT scan of the thorax + upper abdomen + pelvis, a type B thoracic aortic dissection was observed, without subdiaphragmatic extension or extension to the supraaortic trunks, without mediastinal effraction, and a right adrenal tumour of approximately 3.6 cm was also detected. The patient was directed to the cardiovascular surgery service, where an endoprosthesis with Vaillant prosthesis of the descending aorta and subclavian carotid bypass were performed, with good postoperative evolution. The patient was then referred to The National Institute of Endocrinology "C.I. Parhon" for further investigations required prior to the adrenal surgery. The suspicion of pheochromocytoma was confirmed by urinary metanephrine and normetanephrine dosing, and adrenal surgery was recommended. The patient was placed under alpha and beta blocker treatment for the prevention of hypertensive flares and any potential arrhythmias. Surgical intervention was performed for adrenal tumour resection. Histopathological examination of the surgical sample confirmed the diagnosis of pheochromocytoma. The particularity of the case is the discovery of an adrenal tumour due to an aortic dissection, the patient having no other symptoms and presenting a recorded history of hypertension.