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Case Report
A rare presentation of aortic dissection
1 Medical Student, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
2 Resident, Internal Medicine, Hahnemann University Hospital, Philadelphia, Pennsylvania, United States
3 Fellow, Cardiology, Hahnemann University Hospital, Philadelphia, Pennsylvania, United States
4 Cardiologist, Cardiology, Hahnemann University Hospital, Philadelphia, Pennsylvania, United States
5 Hospitalist, Internal Medicine, Hahnemann University Hospital, Philadelphia, Pennsylvania, United States
Address correspondence to:
Lauren Skerritt
MS4, 2911C Wood Pipe Lane, Philadelphia, Pennsylvania 19129,
United States
Message to Corresponding Author
Article ID: 101064Z01LS2019
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How to cite this article
Skerritt L, Musser L, Parikh M, Rahman T, Madubata C, Patel N. A rare presentation of aortic dissection. Int J Case Rep Images 2019;10:101064Z01LS2019.ABSTRACT
Introduction: Aortic dissection (AD) is a rare, life-threatening event that presents as acute chest pain, radiating to the back, often in the setting of hypertension. Aortic dissection is the most common fatal aortic pathology, yet the initial diagnosis is often missed. Additionally, a minority of patients present with either no symptoms or neurologic symptoms. This patient exhibited atypical presentation of AD and the purpose of this report is to raise awareness.
Case Report: A 79-year-old woman with past medical history of hypothyroidism, osteoporosis, and chronic obstructive pulmonary disease (COPD) presented with bradycardia, acute chest pain, and generalized weakness. She was afebrile, her blood pressure was 100/54 mmHg, heart rate was normal sinus rhythm (NSR) at a rate of 81bpm, respiratory rate 17 breaths per minute. Patient was AO × 3. Physical exam was unremarkable, except for trace pitting edema in bilateral lower extremities. Electrocardiogram (ECG) showed normal sinus rhythm at a rate of 86 with low voltage. Troponin I level was negative × 3. Chest X-ray (CXR) showed no acute cardiopulmonary findings. Transthoracic and carotid echocardiogram revealed a dilated aortic root and dissection of the thoracic aorta. A computed tomography (CT) angiogram of chest, abdomen, and pelvis revealed a Type A AD of the thoracic and abdominal aorta, involving the common carotid arteries, left common iliac, and left external iliac arteries.
Conclusion: Aortic dissection is a life-threatening emergency that requires early detection and treatment to decrease patient morbidity and mortality. However, it is difficult to diagnose as it can present with atypical findings and is frequently mistaken for other etiologies that cause chest pain such as acute coronary syndrome.
Keywords: Aortic dissection, Atypical, Bradycardia, Generalized weakness
SUPPORTING INFORMATION
Author Contributions
Lauren Skerritt - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Lauren Musser - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Meet Parikh - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tahmid Rahman - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Chiduzie Madubata - Substantial contributions to conception and design, Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Naitik Patel - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Lauren Skerritt et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
