Dissection de l’aorte thoracique compliquée d’un syndrome coro narien aigu: un piège diagnostique évitable

peer reviewedLa dissection aortique entreprenant les coronaires constitue un défi diagnostique car le tableau clinique peut être confondu avec un syndrome coronarien aigu en raison des anomalies électrocardiographiques souvent observées. Lorsque c’est le cas, le traitement chirurgical est retardé et un traitement anticoagulant, antiagrégant, voire fibrinolytique peut être erronément entrepris. Le score de détection de la dissection aortique permet d’identifier les patients à risque de dissection aortique. Nous rapportons le cas d’un patient de 60 ans décédé d’une dissection aortique avec tamponnade cardiaque. Le diagnostic initialement retenu étant celui d’un syndrome coronarien aigu, le patient avait été traité par héparine et acide acétylsalicylique. Ce cas illustre le piège diagnostique entre le syndrome coronarien «isolé» et celui associé à une dissection aortique. Nous en profitons pour refaire une revue des recommandations 2020 de l’European Society of Cardiology pour la prise en charge des NSTEMI

Severe Hydrocephalus due to Obstructive Basilar Dolichoectasia of the Third Ventricle.

peer reviewed[en] Vertebro-basilar dolichoectasia (VBD) is a rare pathology of unknown aetiology. Its clinical presentation is wide and prognosis is generally poor with a high mortality rate. Cerebral magnetic resonance imaging is the gold standard for diagnosis. We report an unusual case of intracranial dolichoectasia. VBD was revealed during investigation of a patient with altered mental status. CT brain imaging demonstrated severe obstructive hydrocephalus secondary to compression of the third ventricle. Management is always challenging and depends on the location and the mode of presentation. Our patient died despite surgical management with placement of an external ventricular shunt. LEARNING POINTS: Vertebro-basilar dolichoectasia is a little known cause of altered mental status in elderly patients.An atypical presentation of vertebro-basilar dolichoectasia can mimic extensive cerebrovascular haemorrhage.The prognosis is poor despite prompt diagnosis and the surgical treatment of choice

Haemothorax in a Pregnant Woman Secondary to Rupture of a Pulmonary Arteriovenous Malformation.

peer reviewed[en] Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between the arteries and veins of the pulmonary vasculature leading to a right-to-left shunt. We report the case of a pregnant patient who presented with chest pain revealing a haemothorax secondary to the rupture of an arteriovenous malformation. The diagnosis was made during arteriography after simultaneous performance of an urgent caesarean section and thoracic drainage. LEARNING POINTS: The rupture of a pulmonary arteriovenous malformation in a pregnant patient is a serious and potentially life-threatening event, especially if it is not diagnosed quickly.It is crucial to use whatever imaging test is available whether ionizing or non-ionizing, as no thoracic imaging has been shown to adversely affect the fetus beyond embryogenesis.It is important for emergency doctors to consider this life-threatening condition in the differential diagnosis of atypical chest pain in pregnant women

Dissection de l'aorte thoracique compliquée d'un syndrome coronarien aigue: un piège diagnostique évitable

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