Kronik Tip-B aort diseksiyonlu bir olguda diseksiyonun ilerlemesini taklit eden lomber spondilolistezis

Aort diseksiyonu akut ve ölümcül olan kardiyovasküler bir durumdur. Altmýþ yedi yaþýnda hipertansif kadýn hasta, ani baþlayan, býçak saplanýr tarzýnda alt sýrt aðrýsý nedeniyle, acil servise geldi. Kontrastlý toraks tomografisinde kronik Tip-B aort diseksiyonu tanýsý konuldu. Yoðun bakýma transfer edilen hastaya medikal tedavi baþlandý. Hastanýn aðrýlarýnýn lomber bölgeye yayýlmasý nedeniyle diseksiyonun ilerlediði düþünüldü. Hemodinamik olarak stabil hastaya karýn ultrasonografisi yapýldý ve diseksiyonun ilerlemediði görüldü. Nörolojik incelemesinde lomber spinoz proçes hassasiyeti, her iki bacak germe testinin 30 derecede pozitif olmasý üzerine cekilen manyetik rezonans görüntülemede L3-L4’te spondilolistezis ve merkez yerleþimli disk hernisi tespit edildi. Mevcut bulgularla diseksiyon yönünden operasyon endikasyonu olmadýðý düþünüldü. Diskektomi ve füzyon cerrahisi önerildi. Hastanýn cerrahi tedaviyi kabul etmemesi üzerine, ilaç tedavisi verilerek taburcu edildi. Bu çalýþmada, kronik Tip-B aort diseksiyonlu bir olguda diseksiyonun ilerlemesini taklit eden lomber spondilolistezis’in ayýrýcý tanýdaki önemini vurgulamayý amaçladýk.

Spondylolisthesis mimicking the progression of dissection in a case of chronic Stanford type B aortic dissection

Aortic dissection is an acute lethal cardiovascular condition. A 67-year-old hypertensive woman was admitted to our Emergency Department with an abrupt onset of tearing pain in the interscapular area. A thoracic computed tomography scan with contrast showed chronic type B aortic dissection. The patient was transferred to intensive care and medical therapy was initiated. Upon spread of the pain to the lumbar area, the dissection was thought to have progressed. The patient, being hemodynamically stable, was examined using ultrasonography, and the dissection did not show any progression. In the neurological examination for the lumbar pain, the lumbar processus spinosus was found to be sensitive, and the sciatic nerve stretch test was positive at 30 degrees. Magnetic resonance imaging revealed spondylolisthesis and a centrally located disc herniation at the L3-4 level. No operation for the dissection was planned, but discectomy and fusion surgery was scheduled. Since the patient refused surgery, she was discharged with medical therapy. Our aim in this report was to emphasize the importance of spondylolisthesis mimicking the progression of dissection in the differential diagnosis of a chronic type B aortic dissection case.