Predictive factors of early mortality in patients with type A aortic dissection: association between pulmonary artery adventitial hematoma and type A aortic dissection.

Hirofumi Koike, Eijun Sueyoshi, Chika Somagawa, Reiko Ideguchi, Minoru Morikawa, Ryo Toya

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Article in European radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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6 authors.

Hirofumi KoikeDepartment of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan. kei16231623@gmail.com.ORCID http://orcid.org/0000-0001-9460-0928

Eijun SueyoshiDepartment of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan.

Chika SomagawaDepartment of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan.

Reiko IdeguchiDepartment of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan.

Minoru MorikawaDepartment of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan.

Ryo ToyaDepartment of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan.

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6 · The paper itself

Abstract

objectivesPulmonary artery adventitial hematoma (PAAH) is a potential complication of aortic dissection (AD) that has been shown to have a deleterious effect on prognosis. However, the specific relationship between PAAH secondary to the rupture of type A AD with early mortality has not been fully characterised. We aimed to evaluate the relationship betweeen PAAH and the short-term prognosis of patients with this condition, and to determine how PAAH impacts the prognosis of patients with type A AD compared with other complications of type A AD.

methodsWe retrospectively studied 344 patients with type A AD who were hospitalised at a single institution (164 men and 180 women with a mean [SD] age of 71.0 [12.6] years). These patients were allocated to two groups, comprising those who died within 1 week of the onset of symptoms (early mortality group; n = 33) and those who survived (survival group; n = 311). PAAH was classified according to the CT findings as stage 1 (only in the mediastinum), stage 2 (extending into the lung field ± the interlobular septa), or stage 3 (extending into the alveoli).

resultsThe patient cohort was comprised of 90 (26.2%) patients with PAAH of 344 patients with type A AD. 16 (48.5%) of 33 patients had PAAH in the early mortality group, and 74 (23.8%) of 311 patients had PAAH in the survival group. The early mortality group had higher prevalences of PAAH (p = 0.002), stage 3 PAAH (p < 0.001), pericardial haemorrhage (p = 0.001), mediastinal haemorrhage (p < 0.001), haemothorax (p < 0.001), renal ischaemia (p = 0.002), limb ischaemia (p = 0.001) and myocardial ischaemia (p = 0.004) than the survival group. Furthermore, multivariate analysis showed that age (p = 0.002), stage 3 PAAH (p < 0.001), limb ischaemia (p = 0.010), and myocardial ischaemia (p = 0.001) were risk factors for early mortality.

conclusionsPAAH is not a rare complication of type A AD, and stage 3 PAAH is a risk factor for early mortality. KEY POINTS: Question PAAH due to ruptured type A AD can occur and has been reported to correlate with prognosis. Findings PAAH is not a rare complication of Stanford type A AD, and Stage 3 PAAH is a risk factor with the greatest prognostic value on early mortality. Clinical relevance Knowing that PAAH often occurs with type A AD can help us avoid misdiagnosing stage 3 PAAH as pneumonia or pulmonary oedema.

Indexed as

AdventitiaAortic AneurysmAortic DissectionHematomaPulmonary ArteryAgedAged, 80 and overFemaleHumansMaleMiddle AgedPrognosisRetrospective StudiesRisk FactorsSurvival RateTomography, X-Ray ComputedAortic dissectionComputed tomographyPrognosisPulmonary artery adventitial hematoma

Identifiers

PMID40338341

DOI10.1007/s00330-025-11650-w

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