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Acute aortic dissection: a missed diagnosis
  1. Hiu Fung Wong1,
  2. Paul Bevis2
  1. 1Bristol Medical School, University of Bristol, Bristol, UK
  2. 2Vascular Surgery, North Bristol NHS Trust, Westbury on Trym, UK
  1. Correspondence to Miss Hiu Fung Wong, hw15200{at}


A 60-year-old man with a history of indigestion and untreated hypertension presented with sudden-onset central chest pain which radiated to his back. Acute coronary syndrome was initially suspected but excluded in the emergency department before the patient was discharged. The pain subsequently abated to mild intermittent episodes and was misdiagnosed as indigestion. A week later the patient developed new shortness of breath and ‘flu-like’ symptoms with a positive d-dimer test. CT angiography revealed a Stanford type B aortic dissection which was causing hypoperfusion of the right kidney, resulting in an acute kidney injury. Due to uncontrolled hypertension despite rigorous antihypertensive medication and his failing renal function, the patient underwent endovascular repair and made a good recovery postoperatively.

  • hypertension
  • emergency medicine
  • vascular surgery
  • radiology
  • cardiovascular medicine

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  • 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.