27 July 2018 : Case report
An Atypical Case of Silent Aortic Dissection in a Peritoneal Dialysis Patient: A Case Report and Review of Literature
Unusual clinical course, Challenging differential diagnosis, Management of emergency care, Educational Purpose (only if useful for a systematic review or synthesis)Waqas Javed Siddiqui12ABCDEF*, Ali Arif1EF, Mohammad Harisullah Khan3EF, Maryam Khan1E, Muhammad Owais Hanif12DE, Muhammad Junaid Mahboob4BF, Muhammad Aslam4EF, Aysha Aslam5E, Hasan Arif12BCDF, Sandeep Aggarwal16ABCDF
Am J Case Rep 2018; 19:880-883
BACKGROUND: Aortic dissection presents with acute chest or back pain and is associated with high mortality. We present a case of aortic dissection with an atypical presentation in a peritoneal dialysis patient, and the challenges met with peritoneal dialysis.
CASE REPORT: A 53-year-old African American male presented with progressively worsening exertional dyspnea and orthopnea for 3 days without any history of chest pain. His chest x-ray showed mild pulmonary edema. He was admitted with a diagnosis of heart failure. Bedside echocardiogram revealed severe aortic regurgitation and concern for possible aortic dissection. Computed tomography of chest with contrast showed Stanford type-A aortic dissection extending from the aortic valve to the level of the left subclavian artery. Emergent surgery was performed. Postoperatively, the patient was managed in surgical and trauma intensive care unit to keep the blood pressure in the desired range. Initially, he was started on continuous veno-venous hemodialysis and later on transitioned to intermittent hemodialysis. He was switched back to peritoneal dialysis after 6 weeks of surgery.
CONCLUSIONS: Atypical presentation of a silent aortic dissection without chest pain in the setting of renal failure and other co-morbidities emphasizes that dialysis patients are different from the general population. Sometimes the management needs to be modified from the conventional ways to achieve the high level of success.
Keywords: Dissection, Hypertension, Peritoneal Dialysis, Uremia
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