Atypical presentation and late diagnosis of acute aortic dissection without timely surgical treatment: case report and literature review

Abstract

Acute aortic syndrome includes a group of diseases that have clinical similarity in their natural history, the most important characteristic being their association with a high vital risk. The diagnosis and management of aortic dissection depends on the degree of aortic involvement according to the location of the lesion, as defined by the Stanford classification. In this syndrome, chest pain is considered the cardinal symptom; however, there are situations where clinical feedback is difficult. We present the case of a patient who debuted with a Stanford A aortic dissection, with an indication for surgical resolution in the acute phase, but who unexpectedly presented unspecific clinical manifestations. An opportune diagnosis was not obtained. After repeated consultations for changes in his symptoms, the definitive diagnosis was determined through imaging study, evolving favorably with ambulatory therapy.

Aortic Dissection with Atypical Manifestations During Puerperium: A Case Report

“…In addition to pain, symptoms such as cerebral ischemia, mesenteric ischemia, and findings on physical examination, such as arterial hypertension, although it may be normal on occasion, or diastolic murmur due to aortic valve involvement, can be found. However, findings of an atypical presentation [10] can include nonspecific symptoms such as isolated abdominal pain, migratory pain, syncope, altered consciousness, congestive heart failure, arterial hypotension, cardiogenic shock, focal neurological deficit, transient ischemic attack, or fever of unknown origin. Specifically, during pregnancy or the postpartum period, they can be underdiagnosed due to some normal manifestations in pregnant women.…”

Acute Type A Aortic Dissection Confounded by Aberrant Symptoms

“…Breathlessness was mainly exertional and associated with palpitation and pleuritic chest discomfort. Interestingly, the typical retrosternal chest pain radiating to the back, which is seen in 84.4% of cases [10,12,13] was absent at presentation. Atypical symptoms tend to be less common and more likely to confuse the clinician and lead to misdiagnosis.…”

“…Atypical symptoms tend to be less common and more likely to confuse the clinician and lead to misdiagnosis. They include isolated abdominal pain (30%), pulselessness (30%), heart failure (20%), cardiac tamponade (18%), Transient ischemic attack (20%), focal neurologic deficit (12%), stroke (11%), or sudden death (4%) [10][11][12][13][14]. Another review of the IRAD showed abdominal pain to be associated with increased mortality and to be rare as the primary presenting symptom (4.6%) [14].…”