A silent case of aortic dissection: a case report
Abstract
Type B aortic dissection is a relatively rare clinical condition with, however, a significant clinical impact and therefore an early diagnosis is necessary. The clinical presentation is highly variable depending on the aortic district involved and the presence of signs secondary to hypoperfusion. This peculiarity makes diagnosis even more difficult. We describe the case of a 52-year-old patient who presented to our emergency department with significant chest pain and crisis; his medical history was silent and there were no known cardiovascular risk factors. The ultrasonographic, electrocardiographic, laboratory and semeiological findings and the resulting diagnostic pathways were totally negative. Only advanced diagnostics allowed the diagnosis of aortic dissection. This case allows us to reflect on the interpretation of blood chemistry tests and the application of diagnostic scores/pathways in everyday clinical practice, especially in less defined clinical pictures.
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References
- Aboyans V, Boukhris M. Dissecting the epidemiology of aortic dissection. Eur Heart J Acute Cardiovasc Care 2021;10:710-1. DOI: https://doi.org/10.1093/ehjacc/zuab065
- Pacini D, Di Marco L, Fortuna D et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol 2013;167:2806–12. DOI: https://doi.org/10.1016/j.ijcard.2012.07.008
- EACTS/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Ann Thorac Surg 2024;118:5-115.
- ESC Scientific Document Group. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J 2024;45:3538-7005. DOI: https://doi.org/10.1093/eurheartj/ehae179
- Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes 2015;8:195-203. DOI: https://doi.org/10.1161/CIRCOUTCOMES.114.001384
- Anand SS, Wells PS, Hunt D et al. Does this patient have deep vein thrombosis? JAMA 1998;279:1094-9. Erratum in: JAMA 1998;280:328. Erratum in: JAMA 1998;279:1614 DOI: https://doi.org/10.1001/jama.279.14.1094
- Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 2006;144:165-71. DOI: https://doi.org/10.7326/0003-4819-144-3-200602070-00004
- Van der Hulle T, Cheung WY, Kooij S et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017;390:289-97. Erratum in: Lancet 2017;390:230. DOI: https://doi.org/10.1016/S0140-6736(17)30885-1
- Nazerian P, Mueller C, Soeiro AM et al. Diagnostic accuracy of the aortic dissection detection risk score plus d-dimer for acute aortic syndromes: the advised prospective Multicenter Study. Circulation 2018;137:250-8. DOI: https://doi.org/10.1161/CIRCULATIONAHA.117.029457
- Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation 2005;112:3802-813. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.534198
- Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research. Circulation 2018;137:1846-60. DOI: https://doi.org/10.1161/CIRCULATIONAHA.117.031264
- Watanabe H, Horita N, Shibata Y, et al. Diagnostic test accuracy of D-dimer for acute aortic syndrome: systematic review and metaanalysis of 22 studies with 5000 subjects. Sci Rep 2016;6:26893. DOI: https://doi.org/10.1038/srep26893
- Bima P, Pivetta E, Nazerian P, et al. Systematic review of aortic dissection detection risk score plus D-dimer for diagnostic rule-out of suspected acute aortic syndromes. Acad Emerg Med 2020;27:1013–27. DOI: https://doi.org/10.1111/acem.13969
- Morello F, Bima P, Castelli M, et al. Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study. Eur J Intern Med 2024;128:94-103. DOI: https://doi.org/10.1016/j.ejim.2024.05.029
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