A Diagnostic Dilemma: Abdominal Aortic Dissection Masquerading as Pyelonephritis

This report underscores the urgent necessity of early and accurate diagnosis in cases of aortic dissection (AD) with atypical presentations. A 76-year-old male presented to Al-Zahra Hospital in Isfahan, Iran, with a 7-day history of left flank pain radiating to the left testicle and groin, accompanied by fever, hematuria, and dysuria. Initial assessments, including a kidney and urinary tract ultrasound, revealed severe left kidney hydronephrosis and free fluid, leading to a preliminary diagnosis of pyelonephritis with a possible abscess. Broad-spectrum antibiotics were promptly administered. However, a subsequent CT scan revealed a retroperitoneal hematoma, prompting a CT angiography (CTA), which confirmed an abdominal AD. Despite rapid surgical intervention, the patient succumbed to cardiac arrest. This case highlights the critical importance of vigilance and thorough investigation in patients with atypical symptoms to prevent potentially fatal misdiagnoses.