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All Journal Jurnal Impresi Indonesia Journal of Indonesia Vascular Access
Swempi Melchiadi Abolla
General Practitioner of Mgr. Gabriel Manek, SVD General Hospital, Atambua
Religion Biochemistry, Genetics & Molecular Biology Economics, Econometrics & Finance Education Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Social Sciences

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Conservative management for type A chronic thoracic aortic dissection on a patient with Marfan Syndrome, "when surgery can't be done": a case report from the rural hospital Swempi Melchiadi Abolla; Charles Saputra
Journal of Indonesia Vascular Access Vol. 3 No. 2 (2023): (Available online: 1 December 2023)
Publisher : Indonesian Vascular Access Association (IVAA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/jinava.v3i2.43

Abstract

Introduction: In aortic emergencies, aortic dissection (AD) is one of the most common. This fatal condition affected 2-3 per 100,000 people per year. Predisposing factors initiate the tear through the aorta and create the false lumen. Chronic aortic dissection is often associated with complications that make the aortic wall become weak and can lead to the rupture of the aorta. Chronic aortic dissection also can lead to an ischemic syndrome as a result of gradual impairment of distal perfusion. Emergency surgical intervention in elderly patients with type A aortic dissection is still controversial because of the high postoperative mortality and complication rate. This study aims to discuss the case of a patient who was already diagnosed with chronic aortic dissection with underlying thoracic aortic aneurysm and Marfan syndrome who gets treated conservatively Case Description: We report a case of a 54 years old female who came to the emergency department with the complaint of crushed-felt-like chest pain for the last 3 days accompanied by coughing, nausea, vomiting, and epigastric pain. The patient had been diagnosed with aortic dissection with a thoracic aortic aneurysm two months ago with a history of uncontrolled chronic hypertension and she was also diagnosed with Marfan syndrome. The patient was treated conservatively due to the high risk of mortality and morbidities for cardiac surgery. Conclusion: The decision regarding treatment options for patients with chronic aortic dissection should be considered the outcomes, mortality, and physical function. The physician needs to inform the patient and family about the condition, treatment options, long-term medical management, and the prognosis of the disease.
Unusual Presentation of Pulmonary Tuberculosis with Massive Haemothorax Leading to Obstructive Shock: A Case Report Yudith Megumi Rebhung; Swempi Melchiadi Abolla; Januario E Bria; Charles Saputra
Jurnal Impresi Indonesia Vol. 5 No. 1 (2026): Jurnal Impresi Indonesia
Publisher : Riviera Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58344/jii.v5i1.7401

Abstract

Introduction : Tuberculosis (TB) remains a major global health burden and continues to pose significant diagnostic challenges due to its nonspecific clinical manifestations. Although pleural effusion is a common extrapulmonary manifestation of TB, massive spontaneous haemothorax leading to obstructive shock is exceedingly rare and potentially life-threatening. Case Description : We report the case of a 56-year-old male who presented with progressive dyspnea and was initially diagnosed with cardiogenic shock and acute decompensated heart failure at a referring hospital. Physical examination revealed hypotension, tachycardia, tachypnea, elevated jugular venous pressure, and decreased breath sounds over the left lung. Imaging demonstrated massive left-sided pleural effusion with mediastinal shift. Bedside transthoracic echocardiography showed preserved biventricular function with significant extrinsic cardiac compression. Emergency chest tube placement evacuated approximately two liters of blood, resulting in rapid hemodynamic improvement, confirming the diagnosis of obstructive shock secondary to massive spontaneous haemothorax. Despite negative molecular testing for tuberculosis from sputum and pleural fluid, chest computed tomography revealed findings highly suggestive of pulmonary tuberculosis. Anti-tuberculosis therapy was initiated, leading to further clinical improvement. The patient was discharged in stable condition after five days of hospitalization. Conclussion : This case underscores pulmonary tuberculosis as a rare etiology of massive spontaneous haemothorax causing obstructive shock. Early recognition of obstructive shock, prompt mechanical decompression, and thorough etiological evaluation are critical for optimal outcomes. In the absence of microbiological confirmation, radiological findings play a pivotal role in establishing a diagnosis of clinically confirmed tuberculosis, and early initiation of anti-tuberculosis therapy may be lifesaving
Co-Authors Charles Saputra Charles Saputra Januario E Bria Yudith Megumi Rebhung