Key result
High-risk ADD-RS identifies acute aortic dissection despite a normal D-dimer.
Why the study?
Acute aortic dissection can be fatal if overlooked, and the absence of D-dimer elevation is commonly used to exclude the diagnosis, but cases without D-dimer elevation may be missed.
Case Report (n=1)
This case highlights the importance of using the aortic dissection detection risk score (ADD-RS) alongside D-dimer testing, as acute aortic dissection can occur without D-dimer elevation.
Answers are grounded in this paper and cite their sources.
Normal D-dimer does not exclude aortic dissection in high ADD-risk patients; leaves open D-dimer's rule-out value in this population.
Acute aortic dissection can be fatal if overlooked, and the absence of D-dimer elevation can be used to exclude acute aortic dissection. However, we report a case of acute aortic dissection without D-dimer elevation. A man in his 70s presented to the emergency department with lumbar back pain. D-dimer was <1.0 µg/mL; however, acute aortic dissection was strongly suspected because of the sudden onset of lumbar back pain with a shifting location. Because of a difference in systolic blood pressure in both upper extremities, we performed a thorough examination using contrast-enhanced CT, leading to a diagnosis of acute aortic dissection. The patient was immediately referred to cardiovascular surgery and treated conservatively with antihypertensive management. The aortic dissection detection risk score (ADD-RS) classified the patient as high risk. This suggests the importance of using the D-dimer with the ADD-RS rather than solely relying on the D-dimer results to diagnose acute aortic dissection.
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Saito et al. (2022) conducted a case report in Acute aortic dissection (n=1). Aortic dissection detection risk score (ADD-RS) and D-dimer was evaluated on Diagnosis of acute aortic dissection. Acute aortic dissection was diagnosed in a high-risk patient based on the aortic dissection detection risk score despite a normal D-dimer level (<1.0 µg/mL).
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