Abstract
Background
Acute aortic dissection is the most common life-threatening disorder affecting the
aorta, and can mimic other disease processes. We describe an unusual presentation
of a critically ill patient with initial hematospermia diagnosed with a type A acute
aortic dissection.
Case Report
A 68 year old man presented to a community ED after masturbation and report of blood
in his ejaculate, followed by rapid development of severe low back, chest and hip
pain with shock. ECG showed evidence of ST segment elevation, but suspicion remained
high for thoracic or abdominal aortic catastrophe. Bedside ultrasound demonstrated
no pericardial effusion, a severely hypokinetic myocardium and a question of fluid
in the left perinephric space. Attempts were made to resuscitate the patient, and
an ED chest/abdomen/pelvis CT showed a type A acute thoracic aortic dissection. Unfortunately,
the patient remained profoundly unstable, with multiple arrests. He was transferred
to a tertiary care facility, but expired shortly after arrival.
Why Should an Emergency Physician Be Aware of This?
An emergency physician needs to be aware of the myriad of presentations of acute aortic
dissection. Although hematospermia was felt ultimately to be an incidental symptom,
sexual activity may bring about a significant transient increase in blood pressure,
which could contribute to sheer force causing aortic injury. Awareness of this trigger
and a careful sensitive history may aid the clinician in early diagnosis.
Keywords
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References
- The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.JAMA. 2000; 283: 897
- Insights from the Internal Registry of Acute Aortic Dissection: a 20-year experience of collaborative clinical research.Circulation. 2018; 137: 1846-1860
- Aortic dissections type A during sexual intercourse in male patients: accident or systematic coincidence? Examination of 365 patients with acute aortic dissection within 20 years.Thorac Cardiovasc Surg. 2016; 64: 133-136
- Activity recommendations for postaortic dissection patients.Circulation. 2014; 13: e140-e142
- Spontaneous coronary artery dissection associated with sexual intercourse.Am J Cardiol. 2004; 93: 1323-1324
- Postcoital carotid artery dissection associated with acute cerebral infarction: a case report.Acta Neurol Taiwan. 2009; 18: 267-271
- Postcoital vertebral artery dissection.Am Fam Physician. 1996; 54: 2195-2196
- A rare presentation of a life-threatening condition secondary to masturbatory activity: a case report.J Cardiovasc Disord. 2015; 2: 1012
- Hemospermia.J Urol. 2007; 177: 1613
- Approach to the treatment of aortic dissection.Surg Clin North Am. 2009; 89: 869-893
- Might type A acute dissection repair with the addition of a frozen elephant trunk improve long-term survival compared to standard repair?.Interact Cardiovasc Thorac Surg. 2010; 11: 98
- After dissection: post-op care.http://www.tadcoalition.org/patients-and-caregivers/after-dissection-post-op-careDate accessed: June 26, 2019
Article info
Publication history
Published online: March 20, 2020
Accepted:
January 12,
2020
Received in revised form:
December 4,
2019
Received:
October 18,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
