Using D-Dimer to Diagnose Painless Acute Aortic Dissection: A Case Report

Caroline Barniol,Dominique Lauque,Emilie Dehours,Sandrine Charpentier,Vincent Bounes,Baptiste Vallé

doi:10.1155/2011/395613

Abstract

Introduction. Aortic dissection is a cardiovascular emergency; the most frequent symptom is chest pain, but clinical presentation can be varied and atypical. Case Presentation. We report the case of a 66-year-old Caucasian male who presented a syncope immediately followed by a left-arm weakness while driving his car. Clinical examination was normal, but bilateral jugular vein distension was noted. Electrocardiogram and chest radiography were unremarkable. Among blood tests performed, troponin I test result was negative, and D-dimer test concentration was >4000 ng/mL. Since D-dimer test result was positive, chest computer tomography angiogram was performed and found a thoracic aortic dissection. Conclusion. Our case report shows that acute aortic dissection diagnosis is difficult and must be associated with the interpretation of various clinical signs and D-dimer measurement. It could be helpful for the emergency physician to have a pretest probability D-dimer like in pulmonary embolism diagnosis.

Highlights

Aortic dissection is a cardiovascular emergency; the most frequent symptom is chest pain, but clinical presentation can be varied and atypical
Our case report shows that acute aortic dissection diagnosis is difficult and must be associated with the interpretation of various clinical signs and D-dimer measurement
It could be helpful for the emergency physician to have a pretest probability D-dimer like in pulmonary embolism diagnosis

Summary

Introduction

Aortic dissection is a cardiovascular emergency; the most frequent symptom is a chest pain, but clinical presentation can be varied and atypical [1]. These atypical presentations often lead to a delayed diagnosis. Carrying out a scan confirming this diagnosis hypothesis of aortic dissection is late and may cause a delay of care. This period may be shortened by D-dimer test in the face of any faintness in ICU [2, 3]. This allowed the early implementation of a scanner and rapid surgical supporting of the patient

Case Presentation

Discussion

Conclusion