Author: Mohamed Almaz, Sherif Alkahky, Ricki Leggatt / Editor: Stephen Sheridan / Codes: CC7, SLO3 / Published: 27/04/2026
A 52-year-old man presents to the Emergency Department (ED) with a 2-day history of left-sided chest pain. He describes the pain as a dull ache, which he finds difficult to describe. It does not radiate to his shoulder and is not affected by movement. He is normally fit and well, taking only antidepressant medication. He has no significant cardiac risk factors.
On examination, he appears uncomfortable. His pain improves with oral morphine. Observations show BP 131/82 mmHg in the right arm and 113/72 mmHg in the left arm. Heart rate is 40-45 bpm. Oxygen saturations are 98% on air. Temperature is normal. Cardiovascular and respiratory examinations are unremarkable.
Initial bloods reveal a negative troponin, but the lactate is elevated at 6 mmol/L. Other blood tests are normal. ECG shows sinus bradycardia with no ischaemic changes. Chest X-ray shows no consolidation, but there is loss of the normal aortic knuckle and blurring of the cardiac contour.
D-dimer and CT aortic angiogram are requested. The D-dimer returns at <1000 ng/mL. The CT confirms a Stanford Type B aortic dissection extending from the origin of the left subclavian artery to both common iliac arteries. The superior mesenteric artery, inferior mesenteric artery, and right renal artery arise from the false lumen.
Fig. 2-5 Courtesy of the authors
6 responses
thank you, the explanation about the difference between dynamic and static malperfusion was a new learning point for me.
Great case
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