Left Mandibular Pain: A Rare Initial Symptom of Acute Aortic Dissection Without Coronary Obstruction

Abstract

An 88-year-old woman experienced sharp pain in the left mandible for a few minutes 3 days prior to hospital presentation. On the day of hospital presentation, the patient experienced similar pain and cold sweating for more than an hour early in the morning. On arrival, there was only mild discomfort ranging from the left mandible to the neck, without definite pain. Computed tomography revealed Stanford type A acute aortic dissection. Blood vessel prosthesis implantation was performed. Intraoperatively, the coronary arteries were confirmed to be intact. Mandibular pain is a rare but potential symptom of aortic dissection without coronary artery obstruction.

Diverticulitis in the sigmoid colon presenting with only lower anterior chest pain

“…To test this possibility, further appropriate imaging tests (eg, ultrasonography, thoracic and abdominal CT) are applied 9 . In addition to the patients in our previous reports on referred pain, 1,2 several other patients presenting with pain at an unusual site have been reported. They include a fatal case in which myocardial infarction is presented as a headache 12 and an ectopic pregnancy that is presented as chest pain 13 .…”

“…The relations between sites of pain and the organs involved are complicated, partly because of the presence of referred pain, which may be felt in a part of the body that is distant from, and apparently irrelevant to, the causative organ. We previously reported diagnostically challenging cases in which the only presenting problem was referred pain, such as a case of acute cholecystitis with only lower chest pain 1 or one of acute aortic dissection with only left mandibular pain 2 …”

“…We previously reported diagnostically challenging cases in which the only presenting problem was referred pain, such as a case of acute cholecystitis with only lower chest pain 1 or one of acute aortic dissection with only left mandibular pain. 2 Abdominal pain-usually felt in the left lower abdomen of Caucasians with a high incidence of sigmoid colon diverticula, or in the right or mid-lower abdomen by Asians with a high incidence of right colon diverticula-is the most common symptom of diverticulitis. [3][4][5] The pain might last several days.…”