Aortic Dissection Complicated with Hemothorax in an Adolescent Patient with Systemic Lupus Erythematosus: Case Report and Review of Literature

• Published in: Seminars in arthritis and rheumatism 2011-08, Vol.41 (1), p.12-18
• Main Authors: Wei, Hsin-Yi, MD, Chung, Hung-Tao, MD, Wu, Chang-Teng, MD, Huang, Jing-Long, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Aneurysm, Dissecting - complications; Aneurysm, Dissecting - diagnosis; Aortic Diseases - complications; Aortic Diseases - diagnosis; aortic dissection; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Carotid Intima-Media Thickness; childhood onset; Diagnosis, Differential; Diseases of the aorta; Diseases of the osteoarticular system; Fatal Outcome; hemothorax; Hemothorax - diagnosis; Hemothorax - etiology; Humans; Male; Medical sciences; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Rheumatology; systemic lupus erythematosus
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2010.08.002

Objectives To report a young patient with systemic lupus erythematosus (SLE) complicated by aortic dissection. The relevant literature on the association of SLE and aortic dissection is reviewed. Methods We describe an adolescent patient with childhood-onset SLE diagnosed aortic dissection with presentation of hemothorax. The literature review was performed by a PubMed search using the keywords systemic lupus erythematosus (SLE), aortic dissection, hemothorax, and carotid intima-media thickness (CIMT). Results A 17-year-old male was admitted to the hospital for severe abdominal pain. His past medical history included childhood-onset SLE complicated with lupus nephritis. Acute aortic dissection complicated with hemothorax was diagnosed and he died despite medical therapy. The accelerated CIMT progression of our patient, 0.14 mm in 20 months, might suggest ongoing premature atherosclerotic changes in the aortic wall. On reviewing the English literature, 21 cases of aortic dissection in SLE have been analyzed and discussed. Patients younger than 40 years of age, hypertension, and long-term steroid use are common features of aortic dissection in SLE patients. The possible pathogenesis of aortic dissection in SLE includes atherosclerosis, degeneration, and vasculitis. The widely accepted CIMT measured by ultrasound could be a potential diagnostic tool to access the risk of cardiovascular events. Conclusions Aortic dissection is a rare complication of SLE, but could take place in an adolescent patient with childhood-onset disease. It is important to include aortic dissection as a differential diagnosis in SLE patients with unexplained sharp abdominal, chest, or back pain.