Acute Stanford Type A Aortic Dissection Mimicking Acalculous Cholecystitis: A Case Report

Acute aortic dissection (AAD) is a time-critical cardiovascular emergency that classically presents with abrupt chest or back pain; however, atypical presentations may lead to misdiagnosis, delayed treatment, and worse outcomes. We report a case of AAD presenting with isolated abdominal pain and ultrasound findings mimicking acalculous cholecystitis. A 53-year-old male patient with poorly controlled hypertension and hypercholesterolemia presented with acute-onset epigastric and right upper quadrant pain associated with nausea. Lab evaluation showed direct bilirubin elevation and mild acute kidney injury. Abdominal ultrasound demonstrated gallbladder wall thickening and pericholecystic fluid without gallstones, raising a provisional concern for acalculous cholecystitis. ECG and initial troponin were unremarkable; however, serial troponin elevations prompted further assessment with transthoracic echocardiography (TTE), revealing an intimal flap in the ascending aorta with circumferential pericardial effusion. CT angiography confirmed Stanford type A dissection extending into the infrarenal abdominal aorta, associated with hemopericardium, inferior vena cava reflux, and preserved celiac perfusion. Emergent surgical repair demonstrated a contained rupture with sanguineous pericardial effusion consistent with low-grade tamponade. AAD may therefore present atypically with isolated abdominal symptoms driven by early tamponade physiology and venous congestion rather than visceral malperfusion. In patients with abrupt-onset pain and unexplained serial troponin elevations, timely consideration of dissection is paramount, even in the absence of chest pain.