Medicine · 2025
Unmasking nonspecific pain - clinical clues and diagnostic challenges in acute aortic syndromes: Case series.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Kočan Ladislav, Rybár Dušan, Kolesár Adrián, Lukačin Štefan, Šujanová Alena, Galovičová Andrea, Židzik Jozef, Vašková Janka
Аннотация
RATIONALE: Acute aortic syndromes, including dissection and aneurysm, are life-threatening vascular emergencies that often present with vague, nonspecific pain. Such pain may mimic common musculoskeletal or visceral disorders such as vertebrogenic, renal, or gastrointestinal pain, leading to diagnostic delays and adverse outcomes. This case series underscores how atypical vertebrogenic-like pain can conceal underlying aortic pathology and highlights the importance of early imaging in suspicious cases.
PATIENT CONCERNS: A 56-year-old man with descending thoracoabdominal aortic aneurysm, and 35-year-old man with Stanford Type A ascending aortic dissection.
DIAGNOSES: CT angiography of the aorta due to persistent vertebrogenic back pain despite treatment of lumbar spine pathology revealing a large descending thoracoabdominal aortic aneurysm. In second case a CT scan of the cervical and thoracic spine performed after persistent pain despite cervical vertebrogenic syndrome analgesics treatment led to aortic dissection confirmation.
INTERVENTIONS: Elective surgical repair of aneurysm via thoraco-phreno-laparotomy. The aneurysm was resected and replaced with a 22-mm aorto-aortic Dacron graft. In second case, an emergency surgery with veno-arterial extracorporeal membrane oxygenation support with an open chest due to ongoing uncontrollable hemorrhage was provided.
OUTCOMES: Patient was discharged on postoperative day 7 in stable condition. A second patient passed away of early complications as systemic inflammatory response syndrome, acute renal failure, and circulatory shock.
LESSONS: These cases emphasize the diagnostic challenges of aortic pathologies in the context of misleading clinical features. Physicians must maintain a high index of suspicion for acute aortic syndromes, particularly when encountering atypical or refractory pain in patients with cardiovascular risk factors. Early diagnosis and adherence to guideline-based management are critical to improving survival in these high-risk emergencies.
PATIENT CONCERNS: A 56-year-old man with descending thoracoabdominal aortic aneurysm, and 35-year-old man with Stanford Type A ascending aortic dissection.
DIAGNOSES: CT angiography of the aorta due to persistent vertebrogenic back pain despite treatment of lumbar spine pathology revealing a large descending thoracoabdominal aortic aneurysm. In second case a CT scan of the cervical and thoracic spine performed after persistent pain despite cervical vertebrogenic syndrome analgesics treatment led to aortic dissection confirmation.
INTERVENTIONS: Elective surgical repair of aneurysm via thoraco-phreno-laparotomy. The aneurysm was resected and replaced with a 22-mm aorto-aortic Dacron graft. In second case, an emergency surgery with veno-arterial extracorporeal membrane oxygenation support with an open chest due to ongoing uncontrollable hemorrhage was provided.
OUTCOMES: Patient was discharged on postoperative day 7 in stable condition. A second patient passed away of early complications as systemic inflammatory response syndrome, acute renal failure, and circulatory shock.
LESSONS: These cases emphasize the diagnostic challenges of aortic pathologies in the context of misleading clinical features. Physicians must maintain a high index of suspicion for acute aortic syndromes, particularly when encountering atypical or refractory pain in patients with cardiovascular risk factors. Early diagnosis and adherence to guideline-based management are critical to improving survival in these high-risk emergencies.