Acute Type A Aortic Dissection Confounded by Aberrant Symptoms

Abstract

Acute aortic dissection (AAD) is a cardiovascular emergency that requires emergent surgical, endovascular, or medical intervention depending on the portion of the aorta implicated, as dictated by the Stanford classification, and the extent of aortic involvement. Acute chest pain radiating to the back is typically seen in AAD and may be associated with radial pulse deficits. A high index of suspicion is required to diagnose and initiate management of this emergency as early as possible. This is a report of an atypical presentation of an extensive aortic dissection identified in a young man without most of the typical risk factors, but which was promptly diagnosed and treated.

Keywords: bentall procedure; debakey; stanford; transesophageal echocardiogram; transient ischemic attack; type a acute aortic dissection.

Figure 1. Electrocardiogram (EKG) at first ED visit (left) showing normal sinus rhythm with baseline artifact and EKG at second ED visit (right) showing sinus rhythm and T-wave inversion in V1 and V2

Figure 2. Chest x-ray (CXR) showed diffuse patchy lung infiltrates, concerning possible venous congestion or pulmonary edema with enlargement of the cardio-mediastinal silhouette and double density knob sign

Figure 3. Axial CT angiography of the thorax showing aortic dissection in ascending and descending aorta, aneurysmal dilatation (arrow) of the ascending thoracic aorta, and diffuse patchy bilateral nodular infiltrates

Figure 4. Coronal view of CT angiography of the chest showing aneurysmal dilatation of the aortic root approaching 6 cm with extensive DeBakey type 1 dissection