Histopathology Aiding in the Diagnosis of an Atypical Case of Aortic Dissection

Abstract

INTRODUCTION: Aortic dissection (AD) often presents as acute severe chest or back pain and hemodynamic compromise [1,2]. Early and accurate diagnosis and treatment are crucial for survival. Multiple imaging modalities can be used to demonstrate the dissection, including Computed Tomographic Angiography (CTA), Magnetic Resonance Angiography (MRA), and Transesophageal Echocardiography (TEE). We present a case where a patient with atypical presentation of AD underwent multiple diagnostic studies with inconsistent results. CASE PRESENTATION:A 47-year-old male with history of hypertension, asthma, and tobacco use presented with sudden onset of left-hand numbness, tingling, and pain with associated changes of color in his hand. Patient had sensory deficits in the left hand and left big toe. A left upper extremity (LUE) venous duplex was unremarkable. CTA of the chest showed a filling defect in the right posterior ascending aorta suggestive of an intimal flap. Esmolol was initiated. TEE did not reveal AD. Heparin was initiated. Arterial Doppler of the LUE was negative for any atherosclerotic or thrombotic diseases or evidence of obstruction. The following day, the patient experienced crushing chest pain radiating to the back. Transthoracic echocardiogram showed filling defect in the ascending aorta. Patient was operated on emergently. Although a frank AD was not observed, a mobile pedunculated mass was reported. The affected segment of the aorta was resected and a graft was used for repair. Histopathology results showed focal adventitial hemorrhage and degenerative medial changes consistent with AD.