Stankiewicz Alicja, Moczulska Beata, Izdebska Wiktoria, Wińska Aleksandra, Gromadziński Leszek
Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, al. Warszawska 30, Olsztyn, 10-900, Poland.
Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, Bialystok, 15-089, Poland.
Int J Emerg Med. 2025 Jan 9;18(1):9. doi: 10.1186/s12245-025-00811-9.
Chest pain is a common reason patients are admitted to the hospital. The most clinically significant cases are those in which the pain is due to an immediate life-threatening condition, such as acute aortic dissection (AAD). A prompt and correct diagnosis is crucial to patient survival. This case report of a patient who presented with chest pain confirms the appropriateness of urgent imaging tests e.g. POCUS when AAD is suspected in high-risk patients, regardless of the results of additional laboratory tests such as the D-dimer (DD) assay.
A 72-year-old female patient was brought by the emergency medical team to the emergency room due to fainting without loss of consciousness and severe chest pain. Owing to worsening hypotonia and recurrent chest pain, a thoracic computed tomography (CT scan) was performed and subsequently revealed aortic dissection within the ascending segment with bleeding into the pericardial sac. The results of previously ordered laboratory tests, including the DD assay, were unremarkable and were obtained only after the thoracic CT scan had been acquired. Despite prompt medical intervention, the patient died.
Vigilance is required when diagnosing chest pain in high-risk patients who are suspected of having AAD. The case presented in this report confirms the importance of a thorough history and physical examination as well as prompt diagnostic imaging e.g. POCUS or CT scan. Dedicated laboratory tests such as the DD assay, while often helpful, may fail to reveal remarkable abnormalities in time for medical intervention.
胸痛是患者住院的常见原因。临床上最重要的病例是那些疼痛由即刻危及生命的状况引起的，如急性主动脉夹层（AAD）。及时且正确的诊断对患者存活至关重要。本例胸痛患者的病例报告证实，当怀疑高危患者患有AAD时，无论D - 二聚体（DD）检测等其他实验室检查结果如何，进行紧急影像学检查（如床旁超声心动图）是恰当的。
一名72岁女性患者因晕厥但未失去意识及严重胸痛被急救医疗团队送至急诊室。由于肌张力减退加重及反复胸痛，进行了胸部计算机断层扫描（CT扫描），随后显示升主动脉段主动脉夹层并伴有心包囊出血。先前进行的包括DD检测在内的实验室检查结果无异常，且这些结果是在获得胸部CT扫描后才得到的。尽管进行了及时的医疗干预，患者仍死亡。
对于疑似患有AAD的高危患者，在诊断胸痛时需要保持警惕。本报告中的病例证实了全面的病史和体格检查以及及时的诊断性影像学检查（如床旁超声心动图或CT扫描）的重要性。像DD检测这样的专门实验室检查虽然通常有帮助，但可能无法及时发现显著异常以进行医疗干预。
