The population-level burden and inequities of aortic dissection (AD) mortality in the United States remain incompletely defined, and contemporary, data-driven forecasts are scarce. Using the CDC WONDER Death database (1968–2023), AD deaths were identified by ICD codes (ICD-8/9: 441.0; ICD-10: I71.0). Age-adjusted mortality rates (AAMRs) per 100,000 were stratified by sex, race, age, and Census region. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average APC (AAPC). Forecasts through 2033 employed a Bi-GRU model. We analyzed 175,930 AD-related deaths. Overall, the national AAMR declined by 43 % across 1968–2023 (AAPC −1.10 %, 95 % CI −1.19 to −1.00) but showed a recent upturn (APC +2.00 %, 95 % CI 1.53–2.57). Mortality remained higher in men than women and in Black than White individuals, increased steeply with age, and varied geographically. Bi-GRU forecasts project a modest national decline in AAMR from 1.62 to 1.47 by 2033, with persistent sex (men 1.91 vs women 1.12) and racial (Black 2.32 vs White 1.35) gaps; a slight increase is confined to the South (1.62 → 1.64), while rates in adults ≥85 years improve (10.26 → 9.70). While U.S. AD mortality has nearly halved over five decades, recent increases and persistent demographic and regional disparities highlight uneven progress. Forecasts to 2033 suggest modest overall declines with persistent sex and racial gaps; targeted hypertension control and regional access to high-volume aortic centers remain priorities.

This case represents the association between the presence of large fibroid tumor and pulmonary embolism in 47-year-old women. We highlight the diagnostic investigations and treatment methods for PE, followed by further evaluation of the underlying explanation of this pathology and eliminating other related risk factors.

INPLASY202630021 Management Strategies for Right-to-Left Intraatrial Shunt with Thrombus in Transit: A Systematic Review of 297 Patients and Associated Mortality Outcomes Keywords: Thrombus in tran…

Background: Thrombus in transit (TIT) through a patent foramen ovale (PFO) or atrial septal defect (ASD) is a rare but potentially life-threatening condition associated with paradoxical embolism. Despite advances in imaging and interventional techniques, optimal management strategies remain poorly defined. Objectives: To systematically characterize the clinical presentation, diagnostic approaches, management strategies, and outcomes of adult patients with TIT across right-to-left intra-atrial shunts. Design: Systematic review of published cases. Data sources and methods: Following PRISMA guidelines, PubMed, Embase, and Scopus were searched from inception through March 2025 for case reports, case series, and letters describing adult patients with TIT visualized by transthoracic or transesophageal echocardiography. After screening 1736 records, 278 studies reporting 297 patients were included. Two independent reviewers extracted demographic, clinical, imaging, treatment, and outcome data. Descriptive statistics were summarized, and treatment groups were compared using chi-square and Mann–Whitney U tests. Kaplan–Meier survival curves with log-rank testing assessed 120-day survival, and multivariable Cox regression was used to evaluate potential predictors of mortality. Results: A total of 297 patients from 278 studies were included. The mean age was 58.5 ± 15.8 years, and 50.2% were male. Respiratory symptoms predominated (77.7%), followed by cardiac (29.7%) and neurological (23.0%) manifestations. Provoked events accounted for 70.3% of cases, most commonly in the postoperative setting. Thrombi were detected by transthoracic echocardiography in 92.1% of cases and by transesophageal echocardiography in 100%. Management strategies included surgical embolectomy (57.8%), anticoagulation (36.5%), thrombolysis (13.5%), and percutaneous aspiration (2.7%); 61.1% underwent PFO/ASD closure. Overall mortality was 8.3%. Surgical management was associated with the lowest mortality (3.0%) and the highest short-term clinical improvement (90.5%; p < 0.001). Thrombolysis and percutaneous aspiration were associated with higher mortality (16.6% and 25.0%, respectively). Kaplan–Meier analysis demonstrated superior 120-day survival with surgical management compared with other treatment strategies (log-rank p < 0.001). In multivariable Cox models, no independent predictors of mortality were identified. Conclusion: In this largest synthesis of TIT cases to date, surgical management and PFO/ASD closure were associated with favorable short-term outcomes. Surgical intervention demonstrated the lowest observed mortality, while anticoagulation provided acceptable outcomes in selected patients. Thrombolysis and percutaneous aspiration were associated with higher mortality. These findings support the role of definitive management and shunt closure in selected patients, although prospective studies are needed to establish standardized treatment strategies. Trial registration: This study was registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) (Registration number: INPLASY202630021).