PT - JOURNAL ARTICLE AU - Kanako Saito AU - Shunsuke Soma TI - Aortic dissection diagnosed with the aortic dissection detection risk score of 2 without D-dimer elevation AID - 10.1136/bcr-2022-250680 DP - 2022 Dec 01 TA - BMJ Case Reports PG - e250680 VI - 15 IP - 12 4099 - http://casereports.bmj.com/content/15/12/e250680.short 4100 - http://casereports.bmj.com/content/15/12/e250680.full SO - BMJ Case Reports2022 Dec 01; 15 AB - 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.