Acute Coronary Syndrome and Acute Abdomen Suspected for Type B Aortic Dissection in an Elderly Woman

TL;DR

An elderly woman's aortic dissection was initially misdiagnosed as heart or abdominal issues, highlighting the difficulty in diagnosing this serious condition.

Contribution

This case highlights the diagnostic challenges of type B aortic dissection when symptoms mimic more common conditions.

Findings

The patient's symptoms were initially mistaken for acute coronary syndrome and acute abdomen.

Contrast CT of the abdomen ultimately revealed the correct diagnosis of type B aortic dissection.

The delay in diagnosis underscored the importance of considering rare but serious conditions in elderly patients.

Abstract

Being an uncommon and challenging disorder, acute aortic dissection (AAD) can have fatal outcomes in the event of missed diagnosis or treatment delay. AAD could easily be misdiagnosed, as symptoms usually mimic other common clinical syndromes showing up in Accident and Emergency (A&E), including acute coronary syndrome (ACS), pericarditis, pulmonary embolism, acute abdomen, musculoskeletal pain, as well as presenting as heart failure, stroke, syncope, and absent peripheral pulses.

We present a case of a 77-year-old female who presented to the medical decision unit with acute-onset chest, back, and abdominal pain that occurred on standing for six hours She was thought initially to have acute coronary syndrome based on electrocardiography (ECG) changes, troponin, a normal chest X-ray, and no blood pressure discrepancies in upper extremities. Due to worsening abdominal pain and a previous history of a perforated diverticulum, contrast computed tomography (CT) of the abdomen was arranged and this showed acute type B aortic dissection. By the time the CT was performed, the patient had been in hospital for 16 hours, almost 22 hours from the onset of pain.

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