Acute respiratory distress syndrome (ARDS) is an exceptionally rare complication of acute Stanford type B aortic dissection. We report the case of an 84-year-old woman with hypertension and end-stage renal disease on chronic hemodialysis who presented with acute interscapular and chest pain. Computed tomography angiography confirmed an uncomplicated Stanford type B aortic dissection without rupture, malperfusion syndrome, or other indications for urgent intervention. The patient was initially hemodynamically stable and managed conservatively according to current guideline recommendations. Approximately 24 hours after admission, she developed rapidly progressive dyspnea and severe hypoxemic respiratory failure. Chest imaging demonstrated bilateral pulmonary infiltrates, while cardiogenic, embolic, and infectious causes were systematically excluded. Arterial blood gas analysis revealed a partial pressure of arterial oxygen (PaO₂)/fraction of inspired oxygen (FiO₂) ratio of 67 mmHg, fulfilling the Berlin criteria for severe ARDS. Despite invasive mechanical ventilation, prone positioning, and maximal supportive care, respiratory failure progressed rapidly, resulting in multiorgan failure and death approximately 32 hours after admission. This case highlights a rare but potentially fatal inflammatory complication of acute type B aortic dissection. The temporal association, marked inflammatory response, and exclusion of alternative etiologies support the hypothesis of inflammation-mediated lung injury. Early recognition of unexplained respiratory deterioration may facilitate closer monitoring and timely supportive management, particularly in high-risk patients with advanced age and chronic kidney disease.
Erregui et al. (Sun,) studied this question.