Weifang Medical University.
Linyi People's Hospital.
Kardiologiia. 2022 Jun 30;62(6):74-76. doi: 10.18087/cardio.2022.6.n1818.
We retrospectively studied the diagnosis and treatment of a case of AAD misdiagnosed as stroke since atypical symptoms as the first manifestation, and discussed the clinical features and manifestations, diagnosis, and differential diagnosis of the case in the context of relevant domestic and international literature. The patient, a 49‑year-old male with herpes zoster for more than 1 month, presented with sudden onset of right-sided chest and back pain, accompanied by numbness and weakness of the left limb, and was tentatively diagnosed with post-herpetic neuralgia combined with stroke due to the history of herpes zoster. Non-specific ST-T alterations, D-dimer 20ug / ml, and non-traumatic angiographic findings in the transthoracic and abdominal aorta demonstrated slight thickening of the patient's ascending aorta, and the lumen of the root sinus region showed intimal flap formation with a larger pseudocoel and smaller true lumen, which ultimately confirmed the diagnosis of acute aortic coarctation with atypical presentation. So clinicians need to improve their basic theoretical knowledge, strengthen the understanding of AAD, focus on physical examination, improve relevant auxiliary examinations expeditiously, and pay attention to the significance of specific auxiliary examinations in order to decrease misdiagnosis and missed diagnosis of atypical manifestations of AAD patients.
我们回顾性研究了一例以非典型症状为首发表现的 AAD 误诊为卒中的病例，结合相关国内外文献，探讨了该病例的临床特点、表现、诊断及鉴别诊断。患者为 49 岁男性，疱疹后 1 个月余，突发右侧胸背部疼痛，伴左侧肢体麻木无力，因有疱疹病史，暂诊断为带状疱疹后神经痛合并卒中。非特异性 ST-T 改变，D-二聚体 20ug/ml，经胸及腹主动脉造影未见创伤性改变，仅提示升主动脉稍厚，窦区管腔可见内膜瓣形成，假腔较大，真腔较小，最终明确诊断为急性主动脉缩窄伴非典型表现。因此，临床医生需要提高基础理论知识，加强对 AAD 的认识，重视体格检查，及时完善相关辅助检查，重视特定辅助检查的意义，以减少 AAD 患者不典型表现的误诊和漏诊。
