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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Rapidly Progressive Painless Acute Aortic Dissection: A Case Report
Justin Yang1, Tyler Rigdon1, Kristin Lewis1
1University of California, Irvine, Department of Emergency Medicine, Orange, CA.
Journal of Education & Teaching in Emergency Medicine
|August 6, 2026
Summary
This case study describes a lethal, painless presentation of acute aortic dissection (AAD). It underscores the critical need for reassessment and repeat point-of-care ultrasound (POCUS) in atypical AAD cases.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Emergency Medicine
Background:
- Acute aortic dissection (AAD) classically presents with severe chest or back pain.
- Atypical presentations of AAD can be challenging to diagnose, potentially leading to delayed treatment.
- Painless AAD is a rare but critical subtype requiring high clinical suspicion.
Purpose of the Study:
- To highlight a case of rapidly progressive, lethal, and painless acute aortic dissection.
- To emphasize the diagnostic utility of repeated point-of-care ultrasound (POCUS) in atypical presentations.
- To underscore the importance of vigilant reassessment in emergency medicine.
Main Methods:
- Case report of a 55-year-old female with atypical AAD symptoms.
- Initial point-of-care ultrasound (POCUS) followed by repeat POCUS upon clinical deterioration.
- Computed tomography angiogram (CTA) for definitive diagnosis of Stanford Type A dissection.
Main Results:
- The patient presented with weakness, agitation, and shortness of breath, notably without pain.
- Repeat POCUS, prompted by persistent agitation and abdominal tenderness, revealed aortic dissection.
- Despite resuscitation, the patient experienced rapid deterioration, confirming a lethal outcome.
Conclusions:
- Atypical, painless presentations of AAD can be rapidly fatal.
- Repeated POCUS and vigilant reassessment are crucial for diagnosing subtle cases of aortic dissection.
- This case emphasizes the need for considering AAD even in the absence of pain.
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