Painless Aortic Dissection: A Rare and Atypical Clinical Presentation

Abstract

Aortic dissections (AD) are uncommon, having a high mortality level. It is an extreme vascular emergency that can result in death, when not diagnosed and treated in a timely manner. Diagnosis of Aortic dissection (Type A) can easily be delayed or missed, due to atypical symptoms. A 62 year-old female, without any cardiovascular risk factors, presented to the Emergency Department with digestive symptomatology over fifteen days without any chest pain. Clinically, she was stable, with normal initial laboratory investigations. She consulted a cardiologist, four days later, for progressive dyspnea. A thoraco-abdominal CT was performed confirming the Stanford type A AD above the aortic valve, with a thrombosed dilation extending on 61mm. A transthoracic echocardiogram showed a dilation of the thoracic aorta with type A AD, and a thrombosed false lumen. Urgent surgery was proposed but unfortunately refused by the patient and its family. We get to learn the challenge to diagnose painless AD, through this case, especially when patient comes with atypical symptoms.