We present the case of a female patient in her 60s with multiple medical comorbidities who presented to the emergency department with sudden-onset tearing chest, back and abdominal pain in the setting of a hypertensive emergency. Initial CT-angiography demonstrated mild-diffuse thickening of thoracic and abdominal aorta without signs of intramural haematoma or dissection. The patient was subsequently admitted and medically managed. In the days following admission, the patient developed a small bowel obstruction and neurological deficits. Repeat imaging demonstrated an intramural haematoma extending from left subclavian artery to the diaphragm resulting in foci of spinal cord infarction. Instances of spinal cord infarction secondary to aortic intramural haematoma are rare, with a minority of cases reported as of 2020. This case report highlights a non-classic patient presentation of an intramural haematoma, shedding light onto possible clinical outcomes, treatment options and important risk factors.
- Cardiovascular medicine
- Adult intensive care
- Spinal cord
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Contributors This was a collaborative effort by three medical students under the guidance of an attending physician. TB was the lead author on this project. CB and ACV were key coauthors. VR was the overseeing attending physician.
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.