Related Experiment Videos
Aortic dissection albeit negative d-dimers and zero clinical probability - Another facet of medicine's deadly
Tobias Friedrich Ruf1, Christian Pfluecke1, Christoph Mues1
1Technische Universität Dresden, Heart Center Dresden, University Hospital, Dresden, Germany.
Insights
Even with low clinical probability and negative D-dimer tests, acute aortic dissection can occur. High suspicion is crucial, utilizing multiple diagnostic tools to confirm or exclude this life-threatening condition.
Area of Science:
- Cardiology
- Vascular Surgery
- Emergency Medicine
Background:
- Aortic dissection is a life-threatening condition with high mortality.
- Current guidelines suggest D-dimer testing can rule out aortic dissection in low-risk patients.
- The ADD risk score helps determine clinical probability for aortic dissection.
Observation:
- Two cases of acute aortic dissection are presented.
- Both patients had low clinical probability scores.
- Both patients presented with negative D-dimer values.
Findings:
- Negative D-dimer results and low clinical probability do not exclude acute aortic dissection.
- Diagnostic challenges arise when typical indicators are absent.
Implications:
- Clinicians must maintain a high index of suspicion for acute aortic syndrome.
- A comprehensive diagnostic approach, including imaging and repeat testing, is essential.
- Relying solely on D-dimer tests and risk scores can be misleading in diagnosing aortic dissection.
Abstract:
Aortic dissection, the rupture of the aorta's intimal and medial layers, leading to the formation of a false lumen, is a relatively common disease with high mortality. So far, while not addressing penetrating aortic ulcer or intramural hematoma, current guidelines take a negative value for d-dimers for a sufficient method to rule out aortic dissection in patients with a low clinical probability, as calculated by the ADD risk score. We present two cases of patients with acute aortic dissection, albeit presenting with a low clinical probability for acute aortic dissection and negative values for d-dimers. <Learning objective: One must entertain a high level of suspicion for acute aortic syndrome as even laboratory results within the normal range of d-dimers connected with a low clinical probability can be misleading. According to the patient's symptoms, a battery of different diagnostic tools should play in concert, including imaging studies, repeat clinical evaluation, and repeat laboratory tests, such as d-dimers, before dismissing a diagnosis as severe as aortic dissection.>.