Acute Aortic Dissection Presenting as Rectal Tenesmus

Area of Science:

• Cardiology
• Emergency Medicine
• Radiology

Background:

• Acute aortic dissection (AAD) presents variably, complicating prompt diagnosis in emergency settings.
• Delayed diagnosis of AAD significantly increases mortality rates, highlighting the need for efficient diagnostic strategies.
• Inter-physician variability in imaging use and diagnostic timelines (median >4 hours in ED) contribute to poor outcomes.

Observation:

• A 69-year-old woman presented with gastrointestinal symptoms, initially misattributed to irritable bowel syndrome, delaying her presentation by 12 hours.
• Despite initial atypical symptoms, a thorough history and physical examination led to appropriate risk stratification.
• Computed tomography (CT) of the chest, abdomen, and pelvis with contrast confirmed Stanford Type A aortic dissection.

Findings:

• The Aortic Dissection Detection Risk Score combined with a D-dimer test is the most validated tool for risk stratification.
• Clinical decision-making for CT imaging in suspected AAD should incorporate validated risk assessment tools.
• While imperfect, these tools aid in identifying patients who require urgent imaging and intervention.

Implications:

• Improved diagnostic accuracy for acute aortic dissection through risk stratification can reduce delays and mortality.
• Standardizing the use of risk assessment tools like the Aortic Dissection Detection Risk Score can enhance emergency department protocols.
• Further research into refining diagnostic pathways for AAD is crucial for improving patient survival rates.