Authors: Mario Abalo BAKAI, Tchaa TCHEROU, Eyram Makafui Yoan Yawo Amekoudi, Lihanimpo DJALOGUE, Sylvain MBAIDEDJIM, Nafi OUEDRAOGO, Machihude PIO.
Introduction: Arterial hypertension of the subject is a particular entity, as it requires a meticulous search for the etiology.
Objective: To report the case of an aortic dissection discovered fortuitously during the etiological search for arterial hypertension in a 36-year-old patient.
Clinical Case: Mrs. A., 36 years old, non-smoker, non-alcoholic, followed in nephrology for hypertension and CKD for two years on perindopril 10mg, amlodipine 10mg, indapamide 2.5mg, aldomet 2g, nebivolol 5mg daily treatment regularly taken for more than one (1) year. She had no other cardiovascular history. She had been hospitalized for elevated blood pressure. On examination, blood pressure was 234/145 mmHg, pulse 90bpm, and room air saturation 99%. General condition was good. Cardiac and pulmonary auscultation was normal. ECG showed left ventricular hypertrophy. Creatinemia was 60 mg/l, and CBC showed severe microcytic hypochromic anemia. Transthoracic Doppler echocardiography revealed severe pulmonary hypertension, no visualized intracavitary thrombus, and good biventricular systolic function. DE BAKEY type IIIb aortic dissection. Doppler ultrasonography of the renal arteries had revealed an abdominal aortic aneurysm (3.35cm) post-dissection. The left renal artery (occluded after the ostium), with extension of the dissection to the iliac arteries. Renal ultrasonography revealed small, dedifferentiated stage III kidneys suggestive of chronic renal failure. Thoracic-abdominal-pelvic angioscanner showed CT evidence of a STANDFORD type A aortic dissection extending from the aortic arch to the subrenal abdominal aorta, with a pelvic fluid layer.
Conclusion: Etiological research remains an essential phase in the management of hypertension in young subjects.
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