Clinical Practice and Cases in Emergency Medicine

Introduction: Acute aortic dissection is a life-threatening emergency that may present with nonspecific symptoms, particularly in older adults, leading clinicians to anchor on more common diagnoses.

Case Report: An 85-year-old man presented with four days of cough, weakness, and constipation after a recent emergency department (ED) visit due to food impaction after he choked on a carrot. A chest radiograph obtained the day before admission showed left basal consolidation, prompting referral for suspected aspiration pneumonia. In the ED, he appeared comfortable with no complaints of chest pain. Physical examination noted mild tachycardia and wheezes bilaterally and treatment was initiated with antibiotics and bronchodilators. A low-voltage electrocardiogram led to immediate point-of-care echocardiography, which demonstrated a large circumferential pericardial effusion, a markedly dilated aortic root, and right ventricular collapse. Computed tomography angiography confirmed an extensive Stanford Type A aortic dissection. 

Conclusion: This case highlights how deceptively calm presentations can mask catastrophic disease and why clinicians must be ready to abandon their first diagnosis when the data demands it.