A case of recurrent acute aortic syndrome: Beyond emergency diagnosis and treatment

Abstract

Introduction: Acute aortic syndromes (AAS) are emergency conditions with a common pathway but various clinical manifestations. In order to reduce the extremely poor prognosis, these syndromes require a rapid diagnosis and decision making.Case report: We report the case of a young black woman with recurrent aortic dissection (RAD), presenting to the Emergency Department (ED) with an atypical symptom: ankle soreness. After the surgical treatment, several exams were performed in order to investigate underlying conditions for recurrence: after a first suspicion of tuberculous aortitis, the final diagnosis was Takayasu’s arteritis.Discussion: The aim of this article is to underline the extremely heterogeneous presentation of AAS that worsens the already complicated process in diagnosing the syndromes. Despite uncommon signs and symptoms, identifying patients with a high pre-test likelihood for the disease is crucial to promptly get a correct diagnosis. Once the diagnosis has been confirmed, since AAS may be a spy for important systemic diseases, conditions such as congenital disease, autoimmune and infectious aortitis need to be excluded and treated to prevent any recurrence or systemic implications.