SS–21 Spontaneous Type-A Aortic Dissection in an Adolescent Patient

Abstract

Introduction and Aim: Acute aortic dissection is an emergency cardiovascular pathology with a mortality rate reaching up to 50% within the first 48 hours if not intervened in a timely and accurate manner. Patients frequently present to the emergency department with sudden-onset, sharp/tearing chest pain in the interscapular region or anterior chest wall. However, it may also present atypical presentations such as neurological symptoms, myocardial infarction, or dysphagia. Etiological factors typically include hypertension, connective tissue disorders, bicuspid aortic valve, congenital anomalies, and a positive family history. In this report, we present a case of spontaneous Type-A aortic dissection in a 17-year-old patient who presented with crushing chest pain mimicking acute coronary syndrome, with no known risk factors or predisposing etiological causes.

Case Report: A 17-year-old male patient presented to the emergency department with crushing chest pain that had been ongoing for approximately 30 minutes. The patient had no known chronic diseases or history of trauma, and no marfanoid features were observed on physical examination. His initial 12-lead electrocardiogram (ECG) demonstrated ST-segment elevation and hyperacute T waves in the precordial leads (Fig. 1). Cardiac troponin levels at presentation were negative.

On bedside transthoracic echocardiography (TTE), the aortic root diameter was measured as 5.5 cm, and an intimal dissection flap was observed. To confirm the diagnosis, a chest Computed Tomography (CT) angiography was promptly performed, confirming a Type-A aortic dissection (Fig. 2). The patient was immediately transferred to the cardiovascular surgery operating room, where surgical intervention was successfully performed. Rheumatological and genetic panels performed for etiology revealed no evidence of connective tissue disease. On postoperative follow-up TTE, the aortic root diameter was measured at 4 cm, and the patient was discharged in good health (uneventfully).

Conclusion: Aortic dissection typically develops in older age groups and against the background of an underlying cardiovascular or congenital risk factor. However, given the high risk of mortality, aortic dissection must always be kept in mind in the differential diagnosis of chest pain in young patients presenting with atypical ECG findings, even in the absence of obvious underlying risk factors.