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Aortic dissection: A "humerus" case
1University of Ottawa Heart Institute, Ontario, Canada. Kascah@ottawaheart.ca
Insights
Aortic dissection, a serious condition, may present with chest pain and arm pressure differences. Transesophageal echocardiography revealed a surprise diagnosis beyond typical findings.
Area of Science:
- Cardiology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Aortic dissection typically presents with severe chest pain and mediastinal widening.
- Echocardiography is frequently the initial imaging modality for suspected aortic dissection.
Observation:
- A patient presented with classic signs of aortic dissection, including chest pain and arm pressure differentials.
- Initial transthoracic echocardiography showed aortic enlargement and a flap, suggestive of dissection.
Findings:
- Transesophageal echocardiography provided a surprising and definitive diagnosis.
- The case highlights the importance of considering other para-aortic vascular structures in diagnosing aortic dissection.
Implications:
- This case underscores the diagnostic challenges and potential for unexpected findings in aortic dissection.
- Broadening the differential diagnosis to include adjacent vascular structures can improve diagnostic accuracy.
Abstract:
Aortic dissection usually presents with acute onset of severe chest pain. Classically there is a pressure differential between the 2 arms and widening of the mediastinum. Echocardiography is considered the investigation of choice in many institutions. A case is presented in which the presentation and clinical signs are classical for dissection. Transthoracic echocardiography demonstrated "enlargement" of the descending aorta and a "flap." A surprise diagnosis was made by transesophageal echocardiography. Other vascular structures in the para-aortic regions should be considered when the diagnosis of aortic dissection is entertained.