PMC5465409_01
Images of enhanced CT. Enhanced CT was taken before discharge (a-c) and one year later (d). The entry of the false lumen is indicated by black arrows (a, b). The distal re-entry is located at the bifurcation of the iliac arteries. Thrombus formation (white arrow) developed within 1 year, but the false lumen remained open (c, d). CT: Computed tomography
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Computed tomography (CT) showed dilation of the aortic false lumen with pleural effusion and a moderate amount of pericardial effusion (Fig. 1a-c). Contrast-enhanced CT after one year demonstrated a further delay of blood flow and an increase in the mural thrombus in the false lumen; however, the lumen remained open (Fig. 1d).
Time-course of treatment. Treatments (a) in the hospital and (b) at the outpatient clinic. The patient was successfully treated and discharged after 157 days of hospitalization. Briefly, the consumption of coagulation factors and fibrinogen could be not suppressed by anti-coagulation therapies except by continuous infusion of dalteparin. However, once bleeding occurred, it was difficult to resume infusion. The patient developed two hematomas after using FFP prior to shunt operations. Nevertheless, tranexamic acid quickly improved her condition. After discharge, her symptoms remain controlled with 2,000 mg of tranexamic acid per day. RBCs: red blood cells, Fib: fibrinogen, PLTs: platelets, FFP: freshly frozen plasma, I.V.: intravenous administration, S.C.: subcutaneous administration. AST: aspartate aminotransferase, ALT: alanine aminotransferase, LDH: lactate dehydrogenase
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Intravenous infusion of low-molecular-weight heparin (LMWH), dalteparin sodium, at 5,000 units per day improved the DIC (Fig. 2a). The dose of tranexamic acid was increased to 2,000 mg per day (Fig. 2b).