Aortic dissection presenting with Hemoptysis: a diagnostic challenge

Hemoptysis is the expectoration of blood originating from the lower respiratory tract and has a wide differential diagnosis, ranging from benign conditions to life-threatening diseases that include pulmonary embolism, severe infections, and aortic dissection. We present a 53-year-old male with a history of hypertension, COPD, and smoking, presenting to the emergency department with a two-day history of hemoptysis. In spite of the absence of classical symptoms such as chest pain, his chest X-ray showed mediastinal widening, and further imaging was performed with contrast-enhanced CT angiography. The CT scan confirmed a Stanford Type B aortic dissection. After multidisciplinary review, medical management was decided upon with antihypertensive medications and tranexamic acid. The patient remained hemodynamically stable and was transferred for further management. This case indicates the inclusion of aortic dissection in the differential diagnosis of hemoptysis, even without classic symptoms.