Painless Aortic Dissection-Diagnostic Dilemma With Fatal Outcomes: What Do We Learn?

Saeeda Fatima,Konika Sharma

doi:10.1177/2324709617721252

Abstract

Aortic dissection is the most catastrophic clinical condition that involves the aorta. It has a high mortality as well as high rate of misdiagnosis due to frequent unusual presentation. Typically, it presents with acute chest, back, and tearing abdominal pain. However, it can present atypically with minimal or no pain, making diagnosis difficult. Physicians should always suspect acute aortic dissection in patients with certain clinical conditions like difficult-to-control hypertension, giant cell arteritis, bicuspid aortic valve, intracranial aneurysms, simple renal cysts, family history of aortic disease, and Marfan syndrome, especially when a patient presents with ischemic symptoms involving multiple organ without an obvious cause.

Highlights

Aortic dissection is the most catastrophic clinical condition that involves the aorta. It has complex clinical manifestations, and it has a high delayed and missed diagnosis rate. It presents with acute chest, back, and tearing abdominal pain
Some of the risk factors and comorbid conditions associated with both type A and type B dissection are shown in table 1.2-4 In the International Registry for Aortic Dissection (IRAD), severe chest pain remains the most common presenting feature in both type A and type B acute aortic dissection (AAD)
Painless AAD is more prevalent among patients suffering from type A dissection than type B dissection and is associated with increased mortality.[5]

Summary

Introduction

Aortic dissection is the most catastrophic clinical condition that involves the aorta. A 52-year-old male was transferred to our facility from an outside emergency department (ED) where he presented with a constellation of symptoms including extreme fatigue and diaphoresis for 12 hours, dyspepsia, and an episode of vomiting, black tarry stools, and syncope. His history was significant for hypertension, alcohol abuse, hypothyroidism, and hyperlipidemia, and he was recovering from a recent toe infection requiring surgery. A 78-year-old woman presented to the ED with complaints of nausea, vomiting, anorexia, and generalized weakness for 6 hours These symptoms were preceded by a transient left jaw pain and left arm and leg weakness for a few seconds.

Findings

Discussion

Conclusion