Catastrophic Acute Aortic Dissection in a Young Healthy Patient.

BACKGROUND

Acute type A aortic dissection (ATAAD) typically affects older patients with hypertension or connective tissue disorders; occurrence in young adults without identifiable risk factors is rare and diagnostically challenging.

CASE SUMMARY: A healthy 41-year-old man presented with sudden severe chest pain, markedly elevated blood pressure, and tachycardia. Computed tomography angiography revealed extensive ATAAD involving multiple major vessels. Emergency surgery, including aortic root replacement and frozen elephant trunk repair, was complicated by severe postoperative coagulopathy, end-organ failure, and brain death.

DISCUSSION: Approximately 30% of ATAAD cases are initially misdiagnosed, particularly in young patients with atypical presentations. This case highlights the importance of diagnostic suspicion even without traditional risk factors, and it reinforces recent guidelines from the American College of Cardiology/American Heart Association recommending screening aortic imaging and genetic counseling of first-degree relatives, aiding preventive management.

TAKE-HOME MESSAGES: It is important to maintain high suspicion for ATAAD in young patients. Rapid imaging, immediate surgical intervention, and family screening are essential.