Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2021; 9(1): 232-235
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.232
Type A aortic dissection developed after type B dissection with the presentation of shoulder pain: A case report
Xin-Bo Yin, Xiao-Kai Wang, Su Xu, Cai-Yun He
Xin-Bo Yin, Clinical Nursing Teaching and Research Section, Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Xin-Bo Yin, Xiao-Kai Wang, Department of Emergency, Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Su Xu, Melbourne Dental School, University of Melbourne, Melbourne 3000, Australia
Cai-Yun He, Faculty of Nursing, School of Medicine, Hunan Normal University, Changsha 410013, Hunan Province, China
Author contributions: Yin XB and He CY designed the study; Yin XB and Wang XK analyzed the data; Wang XK and Xu S wrote the manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: We have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cai-Yun He, RN, Professor, Faculty of Nursing, School of Medicine, Hunan Normal University, No. 31 Tongzipo Road, Changsha 410013, Hunan Province, China. hecaiyunhnu@126.com
Received: August 26, 2020
Peer-review started: August 26, 2020
First decision: November 3, 2020
Revised: November 5, 2020
Accepted: November 13, 2020
Article in press: November 13, 2020
Published online: January 6, 2021
Abstract
BACKGROUND

Aortic dissection (AD) is a life-threatening condition with a high mortality rate without immediate medical attention. Early diagnosis and appropriate treatment are critical in treating patients with AD. In the emergency department, patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain. However, it is worth noting that atypical symptoms of AD are easily misdiagnosed.

CASE SUMMARY

A 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain. After careful examination of her previous medical history and contrast-enhanced computed tomography angiography, the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta. The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health.

CONCLUSION

New retrograde type A AD after chronic type B dissection is relatively rare. It is worth noting that a physician who has a patient with suspected AD should be vigilant. Both patient medical history and imaging tests are crucial for a more precise diagnosis.

Keywords: New type A aortic dissection, Chronic type B aortic dissection, Atypical symptoms, Shoulder pain, Misdiagnosis, Emergency setting, Case report

Core Tip: We report a case of new retrograde type A aortic dissection, which developed after type B aortic dissection. This case is special for only presenting mild left shoulder pain. Hence, detailed medical history and imaging tests are crucial for patients with atypical symptoms.