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Diagnostic computed tomography in acute interscapular pain.

Shruti S Joshi1, Mardi Hamra2, David E Newby3

  • 1Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK shrutishree.joshi@gmail.com.

Heart (British Cardiac Society)
|December 26, 2019
PubMed
Summary

Aortic dissection can present with severe chest pain and circulatory shock, mimicking other acute cardiac events. Prompt diagnosis via CT and echocardiogram is crucial for timely intervention.

Keywords:
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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Radiology

Background:

  • Aortic dissection is a life-threatening condition often presenting with acute chest pain.
  • Early recognition and diagnosis are critical for patient survival and improved outcomes.

Observation:

  • A 60-year-old male with no prior medical history presented with sudden, severe interscapular pain and circulatory shock.
  • Physical examination revealed signs of hemodynamic compromise, including hypotension and elevated jugular venous pressure.
  • Electrocardiogram (ECG) showed a broad QRS complex, and CT imaging of the aorta was performed.

Findings:

  • CT imaging revealed aortic dissection (Figures 1B-D).
  • Bedside echocardiogram demonstrated severe left ventricular systolic dysfunction with apical and lateral wall akinesia.
  • Emergency invasive coronary angiogram was performed.

Implications:

  • This case highlights the importance of considering aortic dissection in patients presenting with acute chest pain and shock, even with atypical ECG findings.
  • Multimodal imaging, including CT and echocardiography, is essential for accurate diagnosis and management.
  • Prompt diagnosis and intervention for aortic dissection can significantly impact patient outcomes.