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Unusual presentation of more common disease/injury
CASE REPORT
Atypical presentation of type B aortic dissection mimicking appendicitis managed medically
  1. Muhammad Azharuddin1,
  2. Maria Amanda Delacruz1,
  3. Derek Baughman2,
  4. Patton Chandler3
  1. 1Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
  2. 2Department of Medicine, St. George School of Medicine, St. George, West Indies, Grenada
  3. 3Pulmonology and Critical Care Department, Monmouth Medical Center, Long Branch, New Jersey, USA
  1. Correspondence to Dr Muhammad Azharuddin, azhar_uddin203{at}yahoo.com

Summary

This is a case of a 53-year-old male patient with a history of hypertension who developed sudden onset of right lower quadrant pain. On arrival, chest X-ray showed prominent aortic arch without cardiomegaly. CT of the abdomen/pelvis showed aortic dissection in descending aorta without rupture. CT of the chest displayed sparing of ascending and aortic arch. Ultrasound Doppler of the kidney displayed mild renal artery stenosis. Differential diagnosis was acute appendicitis, acute ureteric and severe gastroenteritis. The patient was started on oral blood pressure (BP) medicine to titrate off intravenous nicardipine and esmolol drip. After 10 days, he was switched to oral BP medicine. His leg pain was resolved with normal palpable pulse. One week later, his kidney function worsened. Thus, Lasix and minoxidil were stopped. The patient had no chest/abdominal pain and was tolerating the medicine well during his 2-week follow-up. Acute aortic dissection can be a fatal clinical emergency. Timing is critical during diagnosis and management of patients.

  • cardiovascular medicine
  • hypertension
  • renal system
  • back pain

https://doi.org/10.1136/bcr-2018-225378

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    Footnotes

    • Contributors All authors contributed equally in the making of this case report. MA and PC designed the case report concept. MAD retrieved patient consent form. MA, MAD and DB worked on case presentation. MA and MAD composed first draft of the case report. MA and DB worked on the second and final draft of full case report. PC, MAD, DB and MA checked for accuracy and finally agreed on the end result.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.