Aortic dissection albeit negative d-dimers and zero clinical probability - Another facet of medicine's deadly chameleon

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• 作者：Tobias Friedrich Ruf ; MD ; ^{tobias.ruf@mailbox.tu-dresden.de} ; Christian Pfluecke ; MD ; Christoph Mues ; MD ; Ruth H. Strasser ; MD
• 关键词：Aortic dissection ; d-Dimers ; ADD risk score ; 3D CT ; Echocardiography
• 刊名：Journal of Cardiology Cases
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：15
• 期：2
• 页码：53-55
• 全文大小：767 K
• 卷排序：15

文摘

Aortic dissection, the rupture of the aorta's intimal and medial layers, leading to the formation of a false lumen, is a relatively common disease with high mortality. So far, while not addressing penetrating aortic ulcer or intramural hematoma, current guidelines take a negative value for d-dimers for a sufficient method to rule out aortic dissection in patients with a low clinical probability, as calculated by the ADD risk score. We present two cases of patients with acute aortic dissection, albeit presenting with a low clinical probability for acute aortic dissection and negative values for d-dimers.<Learning objective: One must entertain a high level of suspicion for acute aortic syndrome as even laboratory results within the normal range of d-dimers connected with a low clinical probability can be misleading. According to the patient's symptoms, a battery of different diagnostic tools should play in concert, including imaging studies, repeat clinical evaluation, and repeat laboratory tests, such as d-dimers, before dismissing a diagnosis as severe as aortic dissection.>