Returning to the question of the diversity of clinical mascs in aortic aneurysm dissection

Acute aortic dissection is often referred to as the «grand masquerade» due to the variety of clinical manifestations. Since clinical manifestations often include symptoms and signs associated with other diseases, such as acute coronary syndrome, cardiac arrhythmia, pulmonary embolism and stroke, the initial misdiagnosis of aortic dissection occurs in up to 34 % of cases.
We present a clinical case of a 54-year-old man with hypertension, whose clinical symptoms include chest pain and lower jaw pain combined with transient neurological symptoms and atrial fibrillation.
Transthoracic echocardiogram revealed dilatation of the ascending aorta and arch, membrane dissection in the ascending aorta. CT scan of the thoracic and abdominal aorta with contrast: Stanford type A and B aortic dissection.
The patient underwent the Bentall-de Bono procedure at the first stage with a positive effect.
Thus, timely differential diagnostics and instrumental studies improve clinical outcomes in aortic dissection.

1. Isselbacher, E. M., Preventza, O., Black, J. H. 3rd, Augoustides, J. G., Beck, A. W., Bolen, M. A., Braverman, A. C., Bray, B.E., Brown-Zimmerman, M. M., Chen, E. P., Collins,, T. J., DeAnda, A. Jr., Fanola, C. L., Girardi, L. N., Hicks, C. W., Hui, D. S., Jones, W. S., Kalahasti, V., Kim, K. M., Milewicz, D. M., Oderich, G. S., Ogbechie, L., Promes, S. B., Ross, E. G., Schermerhorn, M. L., Times, S. S., Tseng, E. E., Wang, G. J., Woo, Y. J. (2022). 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 146, 334-482. DOI: 10.1161/CIR.0000000000001106.

2. Levy, D., Sharma, S., Grigorova, Y. et al. (2024). Aortic Dissection. In: StatPearls. Treasure Island (FL): StatPearls Publishing [Website]. Retrieved October 10, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK441963.

3. Yee, J., Kendle, A. P. (2022). Aortic Dissection Presenting as a STEMI. J Educ Teach Emerg Med., 7(3), 26-54. DOI: 10.21980/J8W647.

4. Daily, P. O., Trueblood, H. W., Stinson, E. B. et al. (1970). Management of acute aortic dissection. Ann Thorac Surg., 10, 237-247.

5. Hagan, P. G., Nienaber, C. A., Isselbacher, E. M. et al. (2000). The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 283, 897-903.

6. Trimarchi, S., Tolenaar, J. L., Tsai, T. T., Froehlich, J., Pegorer, M., Upchurch, G. R., Fattori, R., Sundt, T. M. 3rd, Isselbacher, E. M., Nienaber, C. A., Rampoldi, V., Eagle, K. A. (2012). Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD. J Cardiovasc Surg (Torino), 53, 161-168.

7. Klompas, M. (2002). Does this patient have an acute thoracic aortic dissection? JAMA, 287, 2262-2272.

8. Erbel, R., Aboyans, V., Boileau, C., Bossone, E., Bartolomeo, R. D., Eggebrecht, H., Evangelista, A., Falk, V., Frank, H., Gaemperli, O., Grabenwöger, M., Haverich, A., Iung, B., Manolis, A. J., Meijboom, F., Nienaber, C. A., Roffi, M., Rousseau, H., Sechtem, U., Sirnes, P. A., Allmen, R. S., Vrints, C. J.; ESC Committee for Practice Guidelines (2014). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. European Heart Journal, 35, 2873-2926. DOI:10.1093/eurheartj/ehu281.

9. Gaul, C., Dietrich, W., Friedrich, I., Sirch, J., Erbguth, F. J. (2007). Neurological symptoms in type A aortic dissections. Stroke, 38(2), 292-297. DOI: 10.1161/01.STR.0000254594.33408.b1.

10. Liu, Z. Y., Zou, Y. L., Chai, B. L. et al. (2014). Analysis of clinical features of painless aortic dissection. J Huazhong Univ Sci Technol Med Sci., 34(4), 582-585.

11. Chew, H. C., Lim, S. H. (2006). Aortic dissection presenting with atrial fibrillation. Am J Emerg Med., 24, 379-380.

12. Lardi, C., Lobrinus, J. A., Doenz, F. et al. (2014). Acute aortic dissection with carotid and coronary malperfusion: from imaging to pathology. Am J Forensic Med Pathol., 35, 157-162.

13. Baumgartner, H., Falk, V., Bax, J. J., De Bonis, M., Hamm, C., Holm, P. J. et al. (2017). 2017 ESC/ EACTS Guidelines for the management of valvular heart disease. EurHeart J., 38(36), 2739-2791.

14. Vendramin, I., Lechiancole, A., Piani, D., Deroma, L., Tullio, A., Sponga, S., Milano, A. D., Onorati, F., Bortolotti, U., Livi, U. (2021). Type A acute aortic dissection with ≥40-mm aortic root: results of conservative and replacement strategies at long-term follow-up. Eur J Cardiothorac Surg., 59(5), 1115-1122. DOI: 10.1093/ejcts/ezaa456.

15. Nishida, H., Tabata, M., Fukui, T., Takanashi, S. (2016). Surgical Strategy and Outcome for Aortic Root in Patients Undergoing Repair of Acute Type A Aortic Dissection. Ann Thorac Surg., 101(4),1464-1469.