title: [Images in cardiology after clinical observation - aortic dissection in Marfan syndrome].
abstract: BACKGROUND
  Stanford type A aortic dissection is a rare phenomenon with high short-term mortality and clinical manifestations that can make differential diagnosis a lengthy process requiring several diagnostic examinations.
  
  
  OBJECTIVE
  Based on a case report, the aim is to highlight the importance of physical examination in the initial management of these patients and of rapid access to a surgical center. A brief review follows on the diagnosis and treatment of ascending aortic dissection, and its specific nature in Marfan syndrome.
  
  
  METHODS
  A 33-year-old man was admitted to the emergency department of a district hospital with chest and back pain associated with vomiting, 20 hours after symptom onset. Initial physical examination revealed an aortic systolic murmur and musculoskeletal morphological abnormalities compatible with Marfan syndrome. Given suspected aortic dissection, a transthoracic echocardiogram was immediately performed, which showed an extensive intimal flap originating at the sinotubular junction. He was transferred to the cardiothoracic surgery department of a referral hospital where he was treated by a Bentall procedure.
  
  
  CONCLUSIONS
  In this case, careful physical examination during initial assessment raised the suspicion that this patient was in a high-risk group for aortic dissection, thus avoiding unnecessary and lengthy exams. This diagnosis requires emergent surgical treatment, and so direct contact in real time between those making in the diagnosis and the surgeon is essential, as well as protocols governing immediate access to a surgical center.
authors.affiliation: Serviço de Cardiologia, Hospital Distrital de Santarém, Santarém, Portugal. ncabanelas@gmail.com
authors.forename: Nuno
authors.initials: N
authors.lastname: Cabanelas
authors.forename: Angelo
authors.initials: A
authors.lastname: Nobre
authors.forename: Nuno
authors.initials: N
authors.lastname: Guerra
authors.forename: Javier
authors.initials: J
authors.lastname: Gallego
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ferreira
authors.forename: Catarina
authors.initials: C
authors.lastname: Carvalheiro
authors.forename: João
authors.initials: J
authors.lastname: Roque
authors.forename: Marisa
authors.initials: M
authors.lastname: Peres
authors.forename: Luís
authors.initials: L
authors.lastname: Siopa
authors.forename: Vítor Paulo
authors.initials: VP
authors.lastname: Martins
authors.forename: Graça
authors.initials: G
authors.lastname: Silva
authors.forename: João
authors.initials: J
authors.lastname: Cravino
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D011859:Radiography; D014463:Ultrasonography