A Novel Presentation of Stanford Type A Aortic Dissection with Vaginal Bleeding: A Case Report

TL;DR

A 72-year-old woman presented with vaginal bleeding as the only symptom of a severe aortic dissection, highlighting the importance of considering rare presentations in elderly patients.

Contribution

This is the first reported case of Stanford type A aortic dissection presenting solely with painless vaginal bleeding.

Findings

Isolated painless vaginal bleeding can be a rare presentation of Stanford type A aortic dissection.

Subtle signs like inter-arm blood pressure discrepancy can provide critical diagnostic clues in atypical cases.

The patient underwent successful surgical repair and remained stable three years post-event.

Abstract

This case is unique in that it documents isolated, painless vaginal bleeding as the sole presenting symptom of a Stanford type A aortic dissection (STAAD), a presentation not previously reported. It adds to the literature by expanding the spectrum of atypical aortic dissection presentations and underscores the need to consider this diagnosis in elderly patients with vascular risk factors, even when they present with non-classical symptoms such as unexplained bleeding.

We present a novel case of STAAD in a 72-year-old woman with a history of hypertension, dyslipidaemia, prior hysterectomy, and cholecystectomy. Her primary complaint was a single, transient episode of painless vaginal bleeding. Notable clinical findings included a diminished right radial pulse, a significant inter-arm blood pressure discrepancy, and unremarkable systemic and vaginal examinations. Given these findings, further evaluation was pursued. Computed tomography aortography revealed a STAAD extending from the aortic arch to the bifurcation, involving the left internal iliac artery and a vaginal arterial branch. The patient underwent emergent surgical repair and was discharged in good condition on hospital day 11. At her most recent follow-up, three years post-event, she remained clinically stable with no recurrence.

Isolated painless vaginal bleeding, although uncommon, may indicate life-threatening pathology. Subtle signs, such as inter-arm blood pressure discrepancy, can offer critical diagnostic clues, underscoring the importance of comprehensive evaluation in atypical emergency presentations.

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