title: Acute, proximal aortic dissection with negative D-Dimer assay and normal portable chest radiograph: a case report.
abstract: Acute aortic dissection is one of the most devastating and time-sensitive diagnosis to consider in young adults with chest pain. Military medicine is represented by a larger proportion of 18- to 50-year-old individuals than is seen in the general medical population. Although uncommon in frequency, younger patients are more likely to suffer from proximal, aortic dissections. Chest radiographs and D-Dimer assays are used frequently as risk stratification tools, but have significant limitations in these more proximal dissections. Because of the frequency and lethality of nonspecific presentations, there exists a need for a sensitive screening tool. This case report presents a 43-year-old male with a concerning history and physical examination for aortic dissection, but a normal portable chest radiograph and a normal D-Dimer assay. It highlights the importance of clinical acumen in developing and maintaining a high clinical index of suspicion based on a Bayesian pretest probability model.
authors.affiliation: Naval Medical Center San Diego, Department of Emergency Medicine, 34800 Bob Wilson Drive, San Diego, CA 92134.
authors.forename: Darshan
authors.initials: D
authors.lastname: Thota
authors.affiliation: Naval Medical Center San Diego, Department of Emergency Medicine, 34800 Bob Wilson Drive, San Diego, CA 92134.
authors.forename: Steve
authors.initials: S
authors.lastname: Zanoni
authors.affiliation: Tri-City Medical Center, Department of Emergency Medicine, 4002 Vista Way, Oceanside, CA 92056.
authors.forename: Cary
authors.initials: C
authors.lastname: Mells
authors.affiliation: Naval Medical Center San Diego, Department of Emergency Medicine, 34800 Bob Wilson Drive, San Diego, CA 92134.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Auten
mesh_terms: D000208:Acute Disease; D000328:Adult; D000784:Aortic Dissection / Q000097:blood / Q000000981:diagnostic imaging*; D001014:Aortic Aneurysm / Q000097:blood / Q000000981:diagnostic imaging*; D001027:Aortography; D005188:False Negative Reactions; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D013902:Radiography, Thoracic
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D