A Painless Thoracic Aortic Dissection
  • Youssef Mahmoud
    SHO General Internal Medicine, Ashford and St. Peters NHS Foundation Trust, Ashford
  • Tamer Shalaby
    ST7 Acute and General Internal Medicine HEKSS, Ashford and St. Peters NHS Foundation Trust, Ashford
  • Nazia Rashid
    Consultant Diabetes, Endocrinology and Acute Medicine, Ashford and St. Peters NHS Foundation Trust, Ashford


Thoracic Aortic Dissection, CT Aortogram, D-dimer, EVAR


Thoracic aortic dissection (TAD) has a very high mortality rate and is often missed due to the atypical presentation of patients. We present a case of a man with chronic hypertension, atrial fibrillation (AF) (on regular warfarin) and a previous endovascular aneurysm repair (EVAR), who presented with dyspepsia and was incidentally found to have a ruptured distal thoracic aneurysm on imaging with no obvious clinical signs on examination, nor abnormalities on admission chest x-ray (CXR).



  • Meszaros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L et al. Epidemiology and clinicopathology of aortic dissection. Chest 2000;117:1271–1278.
  • Bickerstaff LK, Pairolero PC, Hollier LH, Melton LJ, Van Peenen HJ et al. Thoracic aortic aneurysms: a population-based study. Surgery 1982;92:1103–1108.
  • Clouse WD, Hallett JW Jr, Schaff HV, Spittell PC, Rowland CM et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc 2004;79:176–180.
  • Tsai TT, Nienaber CA, Eagle KA. Contemporary Reviews in Cardiovascular Medicine. Acute Aortic Syndromes. Circulation 2005;112:3802–3813.
  • Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000;283:897–903.
  • Gerber O, Heyer GE, Vieux H. Painless dissections of the aorta presenting as acute neurologic syndromes. Stroke 1986;17:644–7.
  • Veyssier-Belot C, Cohen A, Rougemont D, Levy C, Amarenco P et al. Cerebral infarction due to painless thoracic aortic and common carotid artery dissections. Stroke 1993;24:2111–2113.
  • Nienaber CA, Eagle KA. Aortic Dissection: New Frontiers in Diagnosis and Management. Circulation 2003;108:628–635.
  • Shimony A, Fillon KB, Mottillo S, Dourian T et al. Meta-analysis of usefulness of d-dimer to diagnose acute aortic dissection. Am J Cardiol 2011;107:1227–34.
  • Sommer T, Feshke W, Holzknecht N, Smekal AV, Keller E et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology 1996;199:347–452.
  • Ince H, Neinaber CA. Diagnosis and management of patients with aortic dissection. Heart 2007;93:266–270.
  • Strayer RJ, Shearer PL, Hermann LK. Screening, Evaluation, and Early Management of Acute Aortic Dissection in the ED. Curr Cardiol Rev 2012;8:152-7.
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    Published: 2016-09-28
    Issue: Vol. 3 No. 6 (view)

    How to cite:
    Mahmoud Y, Shalaby T, Rashid N. A Painless Thoracic Aortic Dissection. EJCRIM 2016;3 doi:10.12890/2016_000443.

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