J Yeungnam Med Sci.  2024 Apr;41(2):128-133. 10.12701/jyms.2023.01319.

Atypical presentation of DeBakey type I aortic dissection mimicking pulmonary embolism in a pregnant patient: a case report

• Lee SH
• Hong JH
• Kim C

• KMID: 2554774
• DOI: http://doi.org/10.12701/jyms.2023.01319

Abstract

Aortic dissection in pregnant patients results in an inpatient mortality rate of 8.6%. Owing to the pronounced mortality rate and speed at which aortic dissections progress, efficient early detection methods are crucial. Here, we highlight the importance of early chest computed tomography (CT) for differentiating aortic dissection from pulmonary embolism in pregnant patients with dyspnea. We present the unique case of a 38-year-old pregnant woman with elevated D-dimer and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, initially suspected of having a pulmonary embolism. Initial transthoracic echocardiography did not indicate aortic dissection. Surprisingly, after an emergency cesarean section, a chest CT scan revealed a DeBakey type I aortic dissection, indicating a diagnostic error. Our findings emphasize the need for early chest CT in pregnant patients with dyspnea and elevated D-dimer and NT-proBNP levels. This case report highlights the critical importance of considering both aortic dissection and pulmonary embolism in the differential diagnosis of such cases, which will inform future clinical practice.

Keyword

Aortic dissection; Case reports; Dyspnea; Pregnancy complications; Pulmonary embolism

Figure

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  Fig. 1. Normal preoperative chest radiography.

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  Fig. 2. Transthoracic echocardiography shows dilated right ventricle (arrowheads) and reduced right ventricular systolic function. (A) Apical four-chamber view. (B) Parasternal short-axis view at mid-ventricle level.

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  Fig. 3. Chest computed tomography shows (A) ascending (coronal view) and (B) abdominal aortic dissection (transverse view). Arrowheads indicate the dissection flap.

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  Fig. 4. (A) Intraoperative transesophageal echocardiography (mid-esophageal long-axis view). The dissection flap (arrowheads) is seen in the proximal ascending aorta. (B) Systolic aortic regurgitation is also seen.

Reference

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