A Case Report on Rapid Progression from Pulmonary Embolism to Acute Aortic Dissection, A Rare and Catastrophic Association

Abstract

Background: Pulmonary Embolism (PE) and Acute Aortic Dissection (AAD) are two life‑threatening cardiovascular emergencies. Their coexistence is exceptionally rare and diagnostically challenging. We report a case of a patient initially admitted for high‑risk intermediate PE who subsequently developed an acute type A dissection, illustrating the need for vigilance and rapid multimodal imaging. Aim: To report an unusual case of bilateral pulmonary embolism complicated shortly thereafter by an extensive type A aortic dissection, and to emphasize the diagnostic value of multimodal bedside imaging in differentiating overlapping cardiovascular emergencies. Case Summary: A 78‑year‑old woman was admitted with bilateral proximal PE associated with extensive femoropopliteal deep vein thrombosis. Initial echocardiography revealed a mildly dilated ascending aorta (40 mm), and CT pulmonary angiography confirmed bilateral PE. The patient remained hemodynamically stable throughout hospitalization. Shortly before discharge, she developed sudden hemodynamic collapse. Bedside echocardiography showed hypovolemia, new pericardial effusion, aortic regurgitation, and suspected intimal flap. Transesophageal echocardiography confirmed an aortic flap extending from the sinuses of Valsalva to the descending aorta. Thoracic CT angiography further delineated an extensive type A dissection. Given the patient's condition and family decision, no surgical intervention was undertaken, and the patient died shortly thereafter. Conclusion: Although rare, sequential occurrence of PE and AAD is possible and must be recognized promptly. This case highlights the essential role of bedside multimodal imaging in the rapid evaluation of shock. Recommendation: Do not exclude the possibility of multiple simultaneous cardiovascular emergencies—one life‑threatening condition may hide another. Repeated bedside multimodal imaging (TTE, TEE, CT) is recommended in case of hemodynamic instability.