Difficulties in Diagnosing Aortic Dissection in Real Clinical Practice

Abstract

INTRODUCTION: The clinical presentation of aortic dissection (AD) is diverse. Along with the classic signs, there are many “masks” that create difficulties in differential diagnosis with diseases having similar symptoms. The difficulties in the diagnosis of AD include rare incidence of the pathology, atypism of the clinical symptoms which can be interpreted as ischemic heart disease, hypertensive crisis, pulmonary embolism, aortic heart disease, neurological pathology, acute surgical pathology, renal colic. In the reported cases, there were symptoms that should have put the doctor on the alert for AD. So, in the first case there were an acute onset with a sharp rise in blood pressure, unusual irradiation of anginal pain to the lumbar region, asymmetry of the pulse and blood pressure on the extremities, development of gangrene of the right leg. In the second case, the symptomatology of degenerative-dystrophic lesion of the spine prevailed, for which the appropriate treatment was given for ten days. Symptoms suggestive of AD: expansion of the abdominal aorta on magnetic resonance imaging of the spine that could suggest involvement of the thoracic aorta in the pathological process, the presence of anemia. The third case — symptomatically classic variant of AD: severe anginal status, pulse and blood pressure asymmetry. Such symptoms as nausea, vomiting, diarrhea, and most importantly, short duration of the observation, did not permit to make a correct diagnosis on admission. In all clinical observations, the analysis of complaints, history, physical and instrumental data ultimately permitted to diagnose AD. CONCLUSION: For the timely diagnosis of AD, it is important to use available methods of instrumental diagnostics, from routine to high-tech ones. Before routing a patient to the department of vascular surgery, it is necessary to provide medical care aimed at slowing down AD, stabilization of hemodynamics, and anesthesia.