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A Painless Thoracic Aortic Dissection.

Youssef Mahmoud1, Tamer Shalaby2, Nazia Rashid3

  • 1SHO General Internal Medicine, Ashford and St Peter's NHS Trust, Ashford, United Kingdom.

European Journal of Case Reports in Internal Medicine
|February 14, 2019
PubMed
Summary
This summary is machine-generated.

Thoracic aortic dissection (TAD) can be fatal and often presents atypically. This case highlights the need for aortic imaging in high-risk patients with non-specific symptoms, even without classic signs of TAD.

Keywords:
CT aortogramD-dimerEVARThoracic aortic dissection

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Area of Science:

  • Cardiology
  • Vascular Surgery
  • Emergency Medicine

Background:

  • Thoracic aortic dissection (TAD) carries a high mortality rate.
  • Diagnosis can be challenging due to atypical patient presentations.
  • Risk factors include hypertension and pre-existing aortic conditions.

Purpose of the Study:

  • To report a case of incidentally discovered ruptured thoracic aortic aneurysm.
  • To emphasize the importance of considering TAD in patients with atypical symptoms.
  • To highlight diagnostic challenges in patients with multiple comorbidities.

Main Methods:

  • Case report of a patient with hypertension, atrial fibrillation on warfarin, and prior EVAR.
  • Incidental finding of a ruptured distal thoracic aneurysm on imaging.
  • Review of clinical presentation, diagnostic workup, and management considerations.

Main Results:

  • The patient presented with dyspepsia, with no classic signs or symptoms of TAD.
  • A ruptured distal thoracic aneurysm was incidentally identified on imaging.
  • Initial chest X-ray and physical examination showed no abnormalities.

Conclusions:

  • Classic symptoms of TAD, like tearing pain and blood pressure differentials, may be absent.
  • Consider aortic imaging for high-risk patients presenting with syncope, focal neurology, or atypical pain.
  • D-dimer testing may potentially aid in ruling out TAD in the future.