An 80+-year-old male patient presents with ‘indigestion pain | Figure 1

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Emergency Medicine

An 80+-year-old male patient presents with ‘indigestion pain’ and a very mild niggle in the back. He has a history of chronic backpain. He tells you he thinks it’s his indigestion and the back pain is from gardening. But his discomfort started suddenly while at work in the garden. He has a visible hiatus hernia on chest radiograph but no mediastinal widening, BP on the higher side. D-dimer was ‘accidentally’ requested: 1000+, prompting an aortogram revealing a type B dissection starting distal to origin of subclavian all the way to the diaphragmatic crus. Although type B, is anyone aware of a link between an enlarged aortic root and aortic dissection of either type (A or B?)

Similar cases

A 67-year-old male presents to the emergency department with severe upper-back pain. It began three hours ago, is tearing in nature and associated with stomach pain. He denies any chest pain, vomiting, diarrhea, or leg pain. He has a history of hypertension, dyslipidemia, and type II diabetes mellitus. He also has a 35-pack year history of smoking. On physical examination, his blood pressure is 165/105 mmHg and there is diffuse abdominal tenderness. He has normal heart sounds, denies flank tenderness, and there are no signs of lower limb ischemia. A CT reveals a Stanford type B aortic dissection. Which of the following features of this case is most predictive of mortality? Image credit: @BrendaLahlou.

CT Chest demonstrates a significant aortic aneurysm and thoracic stent commonly known as a “Thoracic Endovascular Aneurysm Repair” (TEVAR) for acute Type B aortic dissection

65 yo male patient presents to the ER with shortness of breath. Aortic Type B dissection aneurysm, confirmed by CT.

Aortic dissection is an infrequent diagnosis that usually presents with acute onset of sharp and severe tearing pain. It rarely presents with atypical symptoms, accompanied by a higher mortality risk that arises the delay in diagnosis. In this report, we discuss a type A aortic dissection case with a presentation of heaviness-like chest pain with no evidence of aortic dissection in his first echocardiography. The patient was treated for acute coronary syndrome (ACS), but on the follow-up, echocardiography aortic dissection was diagnosed accidentally. Differentiation between ACS and aortic dissection is critical in patient management. Each one has an entirely different treatment approach, and misdiagnosis can lead to catastrophic outcomes.