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Introduction: Aortic dissection (AD) is an emergency, rarely found and have many clinical manifestations. The diagnosis can be delayed or undiagnosed. This must be fast and precise in order to determine the appropriate management and avoid complications/ death. Case Illustration: A 76 years old man, came to ER due to weakness after fainting, stabbed chest and stomach pain radiating to the back. He suffering hypertension uncontrolled, heavy smoker. Three months ago, he experienced a similar complaint, and underwent TEVAR surgery. On examination BP was 210/125mmHg, HR 95x/m, BMI 15.5 kg/m2, VAS 6/10, throbbing lump in the hypogastric region, creatinine 2.2 mg/dl, D-Dimer 8500 Ng/ml, and abdominal aortic aneurysm, mural thrombus lumen patency 64% on MSCT. Discussion: He was diagnosed type B AD post TEVAR and given conservative management. Typical symptoms fainting, acute stabbed chest and stomach pain radiating to the back, male, uncontrolled hypertension, smoking, pulsating lump in the hypogastric region, minimal pleural effusion caused by inflammatory processes, acute kidney disorders, and aortic aneurysm with high dimer and thrombus. Given acetaminophen due to advanced age and kidney problems, ARB have been proven to slow down aortic enlargement; BB reduce aneurysmal degeneration, progression to chronic AD and improve survival; CCB improve survival. Complications of hypotension may occur so rehydration, reevaluation, monitoring vitals and fluid balance are important. Result: Patient experienced clinical and supportive improvement after 5 days with BP reaching the target <130/80 mmHg. Conclusion: By knowing the clinical picture, investigation and management of these rare emergency cases, patients can be treated well.
Lydia et al. (Wed,) studied this question.