Occult rhabdomyolysis after acute type A aortic dissection

Objectives: We report a case of a patient presenting with an acute type A aortic dissection who presented with bilateral lower extremity paraplegia and development of rhabdomyolysis of the paraspinal muscles during the postoperative period. This discussion includes presentation, clinical course, diagnosis, and management of this rare complication. Data Sources: Data were collected from the patient's electronic medical record and the hospital radiology database. Conclusions: Our case describes rhabdomyolysis of the paraspinal muscles occurring after acute type A aortic dissection. Lumbar arteries that supply the paraspinal muscles may become compromised because of either hypoperfusion or occlusion from aortic cross-clamping, or ligation of the vessels within the false lumen of the dissection, or from atheroembolic phenomena. The resultant ischemia causes edema and necrosis of the paraspinal muscles, subsequently increasing the pressure within the paraspinal compartment. Treatment includes fluid administration, urine alkalinization, and monitoring for signs of acute renal failure. (Crit Care Med 2011; 39:1992-1994)