From the Guidelines
Upper airway obstruction is the exception among the listed complications of aortic dissection. Aortic dissection typically causes complications related to compromised blood flow and pressure effects on surrounding structures.
- Right-sided pleural effusion can occur due to blood leaking into the pleural space from the dissected aorta, as mentioned in the 2010 guidelines for the diagnosis and management of patients with thoracic aortic disease 1.
- Limb ischemia results when the dissection extends into arteries supplying the extremities, reducing blood flow, which is a known complication as stated in the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1.
- Similarly, mesenteric ischemia develops when blood flow to the intestines is compromised by the dissection, also discussed in the 2024 ESC guidelines 1 with a mortality rate of 65%–95%. However, upper airway obstruction is not a typical complication of aortic dissection as the airway structures are anatomically distant from the aorta and are not directly affected by the pathophysiological processes of aortic dissection. While severe aortic dissection can cause various complications including cardiac tamponade, stroke, and acute renal failure, upper airway compromise is not among the expected sequelae of this vascular emergency, and is not listed as a complication in the provided guidelines 1.
From the Research
Complications of Aortic Dissection
The question asks for the exception among the listed complications of aortic dissection: right-sided pleural effusion, limb ischemia, mesenteric ischemia, or upper airway obstruction.
- The provided studies discuss various complications of aortic dissection, including:
- Limb ischemia: This is a known complication of aortic dissection, as discussed in 2, where a case of Stanford type B acute aortic dissection complicated by lower limb ischemia is reported.
- Mesenteric ischemia: This complication is also mentioned in 2 and 3, where the involvement of the celiac trunk and superior mesenteric artery in acute aortic dissection is discussed.
- Upper airway obstruction: Although not directly related to aortic dissection, upper airway obstruction is mentioned in 4 as a complication of the Heimlich maneuver, which can lead to traumatic dissection and rupture of the abdominal aorta.
- However, right-sided pleural effusion is not explicitly mentioned as a complication of aortic dissection in the provided studies.
- While pleural effusion can occur in the context of aortic dissection, the studies provided do not specifically discuss right-sided pleural effusion as a common complication, unlike limb ischemia, mesenteric ischemia, and the rare association with upper airway obstruction through other mechanisms 5. Therefore, based on the information provided, right-sided pleural effusion is the exception among the listed complications of aortic dissection.