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Using d-dimer to diagnose painless acute aortic dissection: a case report.
Caroline Barniol1, Baptiste Vallé, Emilie Dehours
1Pôle de Médecine d'Urgence, Hôpitaux Universitaires de Toulouse, CHU Purpan, TSA 40031, 31059 Toulouse Cedex 9, France.
Case Reports in Emergency Medicine
|January 18, 2013
Summary
Acute aortic dissection can present atypically, with syncope and arm weakness mimicking other conditions. Elevated D-dimer levels are crucial diagnostic indicators for this cardiovascular emergency.
Area of Science:
- Cardiovascular Medicine
- Emergency Medicine
- Diagnostic Imaging
Background:
- Aortic dissection is a life-threatening condition often presenting with chest pain.
- Clinical manifestations can be diverse and non-specific, complicating early diagnosis.
Observation:
- A 66-year-old male presented with syncope and left-arm weakness, without typical chest pain.
- Physical examination revealed bilateral jugular vein distension; ECG and chest X-ray were normal.
- Elevated D-dimer levels (>4000 ng/mL) were detected, prompting further investigation.
Findings:
- A thoracic aortic dissection was confirmed via chest computed tomography angiogram.
- The case highlights the diagnostic challenge posed by atypical presentations of aortic dissection.
Implications:
- Integrating clinical signs with D-dimer testing improves the diagnosis of acute aortic dissection.
- Utilizing a pretest probability score for D-dimer, similar to pulmonary embolism protocols, may aid emergency physicians.
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