Reminder of important clinical lesson
Undiagnosed coarctation of the aorta as a cause of aortic dissection in the young
1 Derriford Hospital, Histopathology, Derriford Road, Crownhill, Plymouth, Devon, PL6 8DH, UK
2 Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
Correspondence to:
Sarah Saunders, ssaunders2{at}hotmail.com
A 35-year-old man presented to the Emergency Department with a history of severe acute central chest pain and simultaneous bilateral paralysis the legs with double incontinence. There was no significant past medical or family history. A CT scan showed a thoracic dissection of the aorta extending from the aortic root to the aortic bifurcation and in to the common iliac arteries. The patient was consented for an axillo-femoral bypass and was taken to theatre and operated on for 7 hours. The patient unfortunately died under anaesthesia. A hospital post-mortem was requested to identify the cause of the dissection. The patient’s heart was sent to a cardiac pathologist who identified an undiagnosed coarctation of the aorta. Genetic testing was negative for Marfan syndrome.
As a result of the post-mortem, it was recommended that first degree relatives of the deceased undergo ultrasound examination of the cardiovascular system as appropriate to exclude coarctation of the aorta.
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