Chest pain? Of course
Back pain? Sure, often times
Abdominal pain? Occasionally
Syncope? Yep
Those are the easy ones.
OK, how ’bout recurrent cough that won’t go away after two weeks and a course of antibiotics? No pain anywhere. Yep. Had a dissection.
See, this is why we often order random stupid studies. It only takes one of these cases and you are so humbled (even if you don’t get sued) that you start scanning everyone. It never ends!!!!
had one that presented as shoulder tip pain
Just yesterday- CT of abdomen for persistent diarrhea. Good thing they got some of the lung so we could catch those bilateral PE’s.
i first presented mine as “dizziness” and that fear of impending doom and was sent home on meclizine. no pain. was my first ever er visit. three days later i went back because the dizziness would not stop and i had one of the same nurses and she told me i was fine and to quit worrying about it. was in an OR a few hours later having my thoracic aortic aneurysm repaired..
to this day i am surprised that i went back. after they sent me home i tried so hard to be ok with what i was feeling but you know- sometimes you just know when something is wrong.
Just out of curiosity- in your patient with the persistent cough, how was the dissection diagnosed? Was it on a CTA that was looking for PE or was it something else that had you go down that route?
It was diagnosed later when someone CT’d her looking for a possible lung mass.
I just had a friend die of Spontaneous cardiac artery dissection in October. What can you do to look out for that?
It’s tragic. It’s often very hard to diagnose. It mimics many other things some of which are benign.
Generally it comes with chest pain going through to the back. It can have passing out, abdominal pain, low back pain, numbness or weakness in the legs suddenly, and sweating.
But often the symptoms are vague or mild so it’s often missed.