Diagnostic Challenges of Aortic Dissection at 5200m- A Case Report Presenting as Neck and Back Emphysema

cute Aortic Dissection (AD) is of great concern due to its high mortality rate. The probability of young patients without underlying diseases developing acute aortic dissection is relatively low. In extreme regions such as high-altitude areas, for patients presenting with atypical chest pain, it is necessary to not only consider life-threatening diseases such as aortic dissection and acute coronary syndrome, but also to rule out the interference of emphysema in the diagnosis. This case provides experience in the diagnosis, evacuation, and treatment of aortic dissection patients in high-altitude areas.

We present the case of a young man who experienced sudden neck pain at an altitude of 5200 m during defecation. The pain persisted and radiated to the back, but there were no typical symptoms of aortic dissection. However, on physical examination, the patient was found to have unequal blood pressure in both arms. After completing a CT scan, the diagnosis was confirmed as aortic dissection with subcutaneous emphysema. The patient was transferred to a hospital at a lower altitude to undergo an “aortic arch replacement under cardiopulmonary bypass.” After follow-up, the patient had a good prognosis and was able to independently perform general daily activities.

The purpose of this case report is to raise awareness of the diagnostic interference caused by subcutaneous emphysema and to emphasize accurate diagnosis and timely intervention when encountering patients with atypical chest pain in high-altitude environments, which is expected to gain a therapeutic time window for the patient.