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Atypical Clinical Presentation of Extensive Aortic Dissection at Mulago Hospital: Case Report

Vululi ST, Rwebembera J, Openy AB and Bugeza S

Acute aortic dissection (AD) has a high morbidity and mortality rates, 1% to 2% of patients with aortic dissection die per hour for the first 24-48 hours after their admission in the hospital. Medical imaging plays a big role in the diagnosis of AD and treatment plan. The present case is a fifty-four year old male admitted at Mulago Hospital in Uganda with sudden onset chest pains, became unconscious for few minutes then recovered the consciousness with ability to walk, stand and sit. Clinical diagnosis prior to radiological investigation was acute coronary syndrome. Surprisingly cardiac Echo showed AD with aortic regurgitation. Computed tomography aortogram showed aortic dissection De Bakey type I. The immediate medical management included intravenous morphine and an oral beta blocker, with a target of maintaining the systolic blood pressure <100 mmHg and the resting heart rate between 60-70 bpm. The patient was discharged from the hospital after eleven days on medical therapy including oral bisoprolol, oral losartan and furosemide. Arrangements for Bentall procedure and Thoracic Endovascular Aortic Repair (TEVAR) were planned in two months at the time of discharge from hospital; unfortunately the patient has never been operated. He has been maintained on medical therapy for three years. The aim of this clinical report is to appreciate the role of radiological investigations in the diagnosis of atypical clinical presentation of extensive aortic dissection.