Key result
A 79-year-old man with multiple cardiovascular risk factors presented with dyspepsia and was incidentally diagnosed with a painless ruptured descending thoracic aortic dissection.
Case Report (n=1)
No
Thoracic aortic dissection can present atypically without pain, emphasizing the importance of considering aortic imaging in high-risk patients with atypical symptoms.
Atypical symptoms may warrant aortic imaging in high-risk patients; leaves open the true frequency of painless dissections.
Thoracic aortic dissection (TAD) has a very high mortality rate and is often missed due to the atypical presentation of patients. We present a case of a man with chronic hypertension, atrial fibrillation (AF) (on regular warfarin) and a previous endovascular aneurysm repair (EVAR), who presented with dyspepsia and was incidentally found to have a ruptured distal thoracic aneurysm on imaging with no obvious clinical signs on examination, nor abnormalities on admission chest x-ray (CXR). LEARNING POINTS: Typical symptoms and signs of thoracic aortic dissection (TAD), such as sudden onset of tearing pain and difference in blood pressure, can be absent in patients.Clinicians should consider imaging of the aorta in high-risk patients who present with syncope, focal neurology and/or atypical chest, back or abdominal pain.There may be a role for D-dimer in the future to rule out the possibility of TAD, similar to pulmonary embolism (PE).
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Mahmoud et al. (2016) conducted a case report in Thoracic aortic dissection (n=1). A 79-year-old man with multiple cardiovascular risk factors presented with dyspepsia and was incidentally diagnosed with a painless ruptured descending thoracic aortic dissection.
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