作为一种不常见且具有挑战性的疾病,急性主动脉夹层(AAD)在漏诊或治疗延迟的情况下可能有致命结局.AAD很容易被误诊,由于症状通常模仿其他常见的临床综合征出现在事故和急诊(A&E),包括急性冠状动脉综合征(ACS),心包炎,肺栓塞,急腹症,肌肉骨骼疼痛,以及表现为心力衰竭,中风,晕厥,和缺乏周边脉冲。我们介绍了一例77岁的女性,她以急性发作的胸部出现在医疗决策部门,回来,以及站立六小时后出现的腹痛。根据心电图(ECG)变化,她最初被认为患有急性冠状动脉综合征,肌钙蛋白,正常的胸部X光片,上肢没有血压差异。由于腹痛恶化和憩室穿孔的病史,布置腹部对比计算机断层扫描(CT),显示急性B型主动脉夹层。在做CT的时候,病人住院16个小时,从疼痛开始将近22小时。
Being an uncommon and challenging disorder, acute aortic dissection (AAD) can have fatal outcomes in the event of missed diagnosis or treatment delay. AAD could easily be misdiagnosed, as symptoms usually mimic other common clinical syndromes showing up in Accident and Emergency (A&E), including acute coronary syndrome (ACS), pericarditis, pulmonary embolism, acute abdomen, musculoskeletal pain, as well as presenting as heart failure, stroke, syncope, and absent peripheral pulses. We present a case of a 77-year-old female who presented to the medical decision unit with acute-onset chest, back, and abdominal pain that occurred on standing for six hours She was thought initially to have acute coronary syndrome based on electrocardiography (ECG) changes, troponin, a normal chest X-ray, and no blood pressure discrepancies in upper extremities. Due to worsening abdominal pain and a previous history of a perforated diverticulum, contrast computed tomography (CT) of the abdomen was arranged and this showed acute type B aortic dissection. By the time the CT was performed, the patient had been in hospital for 16 hours, almost 22 hours from the onset of pain.