Clinical Practice and Cases in Emergency Medicine

Introduction: This case is unique in that it documents isolated, painless vaginal bleeding as the sole presenting symptom of a Stanford type A aortic dissection (STAAD), a presentation not
previously reported. It adds to the literature by expanding the spectrum of atypical aortic dissection presentations and underscores the need to consider this diagnosis in elderly patients with vascular risk factors, even when they present with non-classical symptoms such as unexplained bleeding.

Case Report: We present a novel case of STAAD in a 72-year-old woman with a history of hypertension, dyslipidaemia, prior hysterectomy, and cholecystectomy. Her primary complaint was a
single, transient episode of painless vaginal bleeding. Notable clinical findings included a diminished right radial pulse, a significant inter-arm blood pressure discrepancy, and unremarkable systemic and vaginal examinations. Given these findings, further evaluation was pursued. Computed tomography aortography revealed a STAAD extending from the aortic arch to the bifurcation, involving the left internal iliac artery and a vaginal arterial branch. The patient underwent emergent surgical repair and was discharged in good condition on hospital day 11. At her most recent follow-up, three years post- event, she remained clinically stable with no recurrence.

Conclusion: Isolated painless vaginal bleeding, although uncommon, may indicate life-threatening pathology. Subtle signs, such as inter-arm blood pressure discrepancy, can offer critical
diagnostic clues, underscoring the importance of comprehensive evaluation in atypical emergency presentations.