Case of the Month #30 Aortic Dissection
What are the differential diagnoses and how would investigate them?
- The history and examination findings are classic of aortic dissection, with chest and back pain featuring in up to 80% of presentations (1).
- A full blood panel including a venous gas should be sent. D-dimer is also a useful marker and is raised more rapidly in aortic dissection than other differentials such as pulmonary embolus (1, 2).
- An ECG would be useful to consider pericarditis or acute coronary syndrome.
- Whilst most patients will undergo a chest x-ray in the first instance, computerised tomographic angiography (CTA) is the gold standard investigation. Transoesophageal ultrasound is a second line alternative if the patient is too unstable to transfer out of resus (3).