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Aortic dissection and rupture presenting as suprasternal bruising and neck swelling
Patrick English1, Mukundarao Kishore
1Diabetes and Endocrinology Research Group, 3rd Floor, Clinical Sciences Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK. patrickenglish@doctors.org.uk
Age and Ageing
|July 31, 2002
Summary
Syncope, or fainting, can be a rare symptom of aortic dissection, especially when not accompanied by chest pain. This case highlights unusual signs like neck swelling and bruising, emphasizing the need for broad diagnostic considerations in elderly patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Vascular Surgery
Background:
- A 76-year-old male presented with syncope, neck swelling, bruising, and an absent left carotid pulse.
- Initial assessment included equal blood pressure in both arms and a normal chest X-ray.
Observation:
- Computed tomography revealed thoracic aortic dissection and rupture with significant mediastinal bleeding.
- The patient's presentation included unusual signs such as anterior chest wall bruising.
Findings:
- Syncope without chest pain is an uncommon presentation of aortic dissection.
- Absence of typical signs like pulse deficits or abnormal chest X-ray does not rule out aortic dissection.
Implications:
- This case underscores the importance of considering aortic dissection in elderly patients presenting with syncope, even with atypical symptoms.
- Diagnostic vigilance is crucial, as classic signs may be absent, necessitating advanced imaging for accurate diagnosis.