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Fever of unknown origin in aortic dissection

Fieber unklarer Genese bei Aortendissektion

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Abstract

Aortic dissection is the most devastating sequela of thoracic aortic disorder. Patients with acute aortic dissection typically manifest as an acute onset of severe chest pain, but occasionally present with atypical symptoms including fever of unknown origin. A total of 50 patients from 41 articles based on a complete literature retrieval were included in this study. More patients had a fever prior to pain. The time to presentation was 40.7 ± 105.6 days, the time to diagnosis was 52.9 ± 110.1 days, and the time to surgery/intervention was 1.8 ± 5.6 days. The patients’ temperature on admission was 38.2 ± 0.6 °C and the maximal temperature recorded was 38.8 ± 0.4 °C. Laboratory findings showed increased white blood cell counts, cardiac enzymes, and inflammatory biomarkers. More pronounced laboratory findings of the infectious type than the inflammatory type aortic dissection could be helpful in the differential diagnosis. Half of patients warrant aortic repair with or without valve replacement, less than half of patients were conservatively managed, and a few were interventionally treated or were being followed up. The mortality rate was 9.5 %. Physicians should always bear in mind aortic dissection when patients present with fever of unknown origin particularly in those without chest pain. Laboratory findings may offer inflammatory evidence for the diagnosis. An early diagnosis as well as subsequent treatment is indispensable for patients’ outcomes.

Zusammenfassung

Eine Aortendissektion ist die schwerwiegendste Folge einer Erkrankung der thorakalen Aorta. Patienten mit akuter Aortendissektion zeigen typischerweise plötzlich einsetzende starke Thoraxschmerzen; gelegentlich weisen sie jedoch atypische Symptome auf, zu denen auch Fieber unklarer Genese gehört. Auf der Grundlage einer umfangreichen Literatursammlung wurden insgesamt 50 Patienten aus 41 Beiträgen in die vorliegende Studie aufgenommen. Bei der Mehrzahl der Patienten bestand das Fieber vor den Schmerzen. Die Dauer bis zur Vorstellung beim Arzt betrug 40,7 ± 105,6 Tage, die Dauer bis zur Diagnosestellung betrug 52,9 ± 110,1 Tage, und die Dauer bis zur Operation/Intervention lag bei 1,8 ± 5,6 Tagen. Zum Zeitpunkt der stationären Aufnahme wiesen die Patienten eine Temperatur von 38,2 ± 0,6 °C auf, und die maximal dokumentierte Temperatur betrug 38,8 ± 0,4 °C. In Bezug auf die Laborbefunde zeigte sich eine Erhöhung der Leukozytenzahl, der Herzenzyme und der Entzündungsparameter. Bei Fieber vom infektiösen Typ Aortendissektion waren entsprechende Laborwerte deutlicher erhöht als bei Fieber vom inflammatorischen Typ, was für die Differenzialdiagnose hilfreich sein könnte. Die Hälfte der Patienten benötigte eine Aortenrekonstruktion mit oder ohne Klappenersatz, weniger als die Hälfte der Patienten wurden konservativ therapiert, und einige erhielten eine interventionelle Therapie oder wurden nachbeobachtet. Die Mortalitätsrate betrug 9,5 %. Ärzte sollten stets an eine Aortendissektion denken, wenn sich Patienten mit Fieber unklarer Genese vorstellen, insbesondere bei jenen ohne Thoraxschmerzen. Bei den Laborbefunden findet sich möglicherweise im Bereich der Entzündungswerte ein Hinweis auf die Diagnose. Für die Ergebnisse bei den Patienten ist eine frühzeitige Diagnosestellung mit anschließender Behandlung unabdingbar.

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  1. The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, 351100, Fujian Province, China

    S.-M. Yuan

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Yuan, SM. Fever of unknown origin in aortic dissection. Z Rheumatol 76, 364–371 (2017). https://doi.org/10.1007/s00393-016-0203-2

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