[A case of acute and intense thoracic pain during a dental treatment].

HISTORY AND ADMISSION FINDINGS: We report on a patient with known hypertension, who presented to his general practitioner with severe thoracic pain of sudden onset. The aches had started during a dental treatment. Immediately, the patient was admitted to hospital by the general practitioner because myocardial ischemia was suspected.

INVESTIGATIONS: Neither the electrocardiogram nor the laboratory findings (creatin kinase, troponin I) argued for an acute coronary syndrome. Since the plasma D-dimer level was increased and the transthoracic echocardiography showed discrete signs of right ventricular strain, pulmonary embolism could not be ruled out. Because of the high intensity of pain and for further diagnostics the patient underwent a contrast medium-enhanced computed tomography (CT).

DIAGNOSIS, TREATMENT AND COURSE: The contrast medium-enhanced CT showed a type B acute aortic dissection. According to the current guidelines for the treatment of type B aortic dissection, a conservative therapeutic regimen was applied. Antihypertensive therapy was escalated. Furthermore, the patient transiently received analgesic drugs. After three weeks the patient was released from hospital without pain and with physiologic blood pressure under intensified antihypertensive therapy. A follow up examination three months after the acute aortic dissection showed a constant aortic diameter. Therefore, surgical treatment was not indicated.

CONCLUSIONS: This case report illustrates a typical clinical picture of acute aortic dissection and gives an overview about its epidemiology, classification, pathogenesis, and prognosis. Furthermore, the diagnostic opportunities and the current guidelines for the treatment of acute aortic dissection are discussed.