Background
Acute aortic dissection is an uncommon but life-threatening emergency, which is often missed in up to 38% of patients on initial evaluation, and in up to 28% of patients, the diagnosis is made at autopsy. Painless aortic dissection has been reported, but is relatively uncommon. The mortality rates are estimated at 50% by 48 hours and increase by 1% per hour
if undiagnosed.
Case presentation
We report a case of atypical aortic dissection who presented to ER with subtle unspecific contralateral renal colicky like pain as a primary symptom, which had made the prompt diagnosis very challenging and difficult. Patient had no history of any chronic disease. Vital signs and abdominal examination were normal. Provisional diagnosis of renal colic was made, analgesic was given to control the pain. Laboratory result showed (4+) RBCS in point of care strip testing otherwise were unremarkable, and CT KUB was requested. Provisional CT-KUB reported by radiologist as unremarkable for any genitourinary pathology. On careful review of the above plain CT by emergency physician, there was ecstatic flap like calcification of thoraco-abdominal aorta. Urgent CT with contrast was requested which confirmed Stanford B aortic dissection.
Conclusion
Proper diagnosis of acute aortic dissection can be difficult when patients present atypically, especially with subtle unspecific symptoms. Aortic dissection is to be considered, even without the presence of characteristic pain in elderly specifically and high-risk patients. A heightened level of attention with low threshold of requesting proper imaging elderly or those with high-risk patient with back or flank pain, are needed for better diagnosis and exclude other catastrophic causes like aortic dissection. Also emphasizing on emergency physicians review of the images in emergency department and integration of radiology training in emergency medicine program, which helps in prompt diagnosis