Aortic dissection disguised as musculoskeletal condition: a case report and review of literature.

Background: Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency frequently associated with misdiagnosis and delayed treatment. This paper aims to illustrate the diagnostic challenges of AAD in rehabilitation settings by presenting a case with atypical musculoskeletal symptoms and emphasize the importance of considering vascular emergencies with literature review.

Methods: A 46-year-old male presented to a rehabilitation center with migrating right shoulder pain and proximal weakness. Initial complaint suggested a musculoskeletal disorder; however, further evaluation revealed hypertension, tachycardia, and migratory, intensifying pain. A subsequent computed tomography angiography confirmed AAD. The patient underwent urgent Sun's procedure, including ascending aorta and total arch replacement with stented elephant trunk implantation, which was followed by multidisciplinary rehabilitation due to the secondary ischemic stroke.

Results: The patient's early symptoms closely mimicked musculoskeletal disorders, which delayed his prioritization of seeking medical service. After cardiovascular evaluation and successful aortic repair, the AAD was stabilized. However, he later developed right-sided hemiplegia as a secondary complication and was referred back for neurological rehabilitation, which included repetitive task training, robot-assisted therapy, and functional electrical stimulation. Three months post-surgery, he demonstrated significant functional recovery, with Fugl-Meyer Assessment scores improving from 12/66 to 58/66 for the upper extremity and from 17/34 to 32/34 for the lower extremity.

Conclusion: This case and literature review highlight the diagnostic challenges of AAD presenting as musculoskeletal pain and underscores the need for rehabilitation specialists to maintain a broad differential diagnosis. A high index of suspicion is essential for early recognition and timely referral, especially in patients with overlapping symptoms and vascular risk factors.

Impact: This case adds to the limited body of evidence on AAD presenting with musculoskeletal complaints and may serve to raise clinical awareness. Further studies, including case series and systematic investigations, are needed to better characterize such atypical presentations and guide diagnostic pathways in rehabilitation settings.