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Aortic dissection diagnosed with the aortic dissection detection risk score of 2 without D-dimer elevation
  1. Kanako Saito1 and
  2. Shunsuke Soma2
  1. 1General Medicine, Sannohe Central Hospital, Sannohe, Japan
  2. 2Emergency and Critical Care Center in Department of General Medicine, Aomori Prefecutural Central Hospital, Aomori, Japan
  1. Correspondence to Dr Shunsuke Soma; shuns0114{at}


Acute aortic dissection can be fatal if overlooked, and the absence of D-dimer elevation can be used to exclude acute aortic dissection. However, we report a case of acute aortic dissection without D-dimer elevation. A man in his 70s presented to the emergency department with lumbar back pain. D-dimer was <1.0 µg/mL; however, acute aortic dissection was strongly suspected because of the sudden onset of lumbar back pain with a shifting location. Because of a difference in systolic blood pressure in both upper extremities, we performed a thorough examination using contrast-enhanced CT, leading to a diagnosis of acute aortic dissection. The patient was immediately referred to cardiovascular surgery and treated conservatively with antihypertensive management. The aortic dissection detection risk score (ADD-RS) classified the patient as high risk. This suggests the importance of using the D-dimer with the ADD-RS rather than solely relying on the D-dimer results to diagnose acute aortic dissection.

  • Primary Care
  • Pericardial disease
  • Clinical diagnostic tests

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  • Contributors KS contributed to the design of the study, acquisition of data, interpretation of data and drafting the manuscript. SS contributed to interpretation of data, drafting the manuscript and revising the manuscript critically for important intellectual content. Both authors approved the final version of the manuscript.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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