Huang Jing, Khanna Siya, Macbarb Max
Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA.
Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA.
Cureus. 2024 Aug 18;16(8):e67117. doi: 10.7759/cureus.67117. eCollection 2024 Aug.
Acute aortic dissection (AAD) is a life-threatening condition with high mortality rates. Prompt diagnosis and intervention are crucial to minimize complications; high suspicion for AAD should be exercised in patients presenting with acute sheering chest pain. While obtaining a proper history and performing a physical examination are important in the diagnostic process, not all cases present with typical symptoms. This can make diagnosis challenging, especially in patients who present with cognitive disorientation, making it difficult to take a proper history. We present the case of a 57-year-old male who presented to the emergency department (ED) of a community hospital with cognitive disorientation and abdominal pain that began two days prior to presentation and was associated with nausea, vomiting, and diarrhea. Laboratory results showed that the patient had an elevated white blood cell count, hyperkalemia, acute renal injury, and elevated lactate levels. Initial chest radiography and computed tomography showed no acute findings. Urine toxicology was positive for cocaine. The elevated lactate levels and cocaine use prompted us to order a computed tomography angiography (CTA) of the abdomen and pelvis with suspicion for bowel ischemia. He was found to have an abdominal aortic dissection with extrinsic compression of the patent true lumen. He was then transferred to a tertiary care facility, and a repeat CTA of the chest, abdomen, and pelvis showed a type A aortic dissection with extensive bowel ischemia. The patient was deemed too unstable for surgical repair and expired. The case highlights the challenges of diagnosing AAD due to its varied presentations and emphasizes the importance of maintaining a high suspicion for the condition in high-risk individuals. Additionally, the case highlights the potential complications associated with AAD.
急性主动脉夹层（AAD）是一种危及生命的疾病，死亡率很高。及时诊断和干预对于将并发症降至最低至关重要；对于出现急性剧烈胸痛的患者，应高度怀疑AAD。虽然在诊断过程中获取恰当的病史和进行体格检查很重要，但并非所有病例都表现出典型症状。这可能使诊断具有挑战性，尤其是对于出现认知障碍的患者，难以获取恰当的病史。我们报告一例57岁男性病例，该患者因认知障碍和腹痛就诊于一家社区医院急诊科，腹痛在就诊前两天开始，伴有恶心、呕吐和腹泻。实验室检查结果显示患者白细胞计数升高、高钾血症、急性肾损伤和乳酸水平升高。最初的胸部X线和计算机断层扫描未发现急性病变。尿液毒理学检查显示可卡因阳性。乳酸水平升高和使用可卡因促使我们怀疑肠道缺血，于是对腹部和骨盆进行计算机断层扫描血管造影（CTA）。结果发现他患有腹主动脉夹层，真腔受到外部压迫。随后他被转至三级医疗机构，胸部、腹部和骨盆的再次CTA显示为A型主动脉夹层伴广泛肠道缺血。该患者被认为病情过于不稳定，无法进行手术修复，最终死亡。该病例凸显了因AAD表现多样而导致诊断困难的问题，并强调了对高危个体保持高度怀疑的重要性。此外，该病例还凸显了与AAD相关的潜在并发症。
