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Postgrad Med J 88:729-730 doi:10.1136/postgradmedj-2012-131008
  • Images in medicine

An octogenarian with painless type A aortic dissection and cardiac tamponade

  1. Victor Chao3
  1. 1Department of Cardiovascular Medicine, National Heart Centre Singapore, Singapore
  2. 2Department of Pathology, Singapore General Hospital, Singapore
  3. 3Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
  1. Correspondence to Dr Calvin Woon-Loong Chin, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752, Singapore; cchin03m{at}gmail.com
  1. Contributors All the authors contribute equally to the preparation of the manuscript. The histopathology slide was prepared by S-HL. CC and NK wrote the manuscript which was also reviewed by all the authors before submission.

Introduction

Painless aortic dissection (AD) has a reported prevalence of 6.4% and occur more commonly in older patients.1 They carry a worse prognosis compared with patients with painful AD. In patients with type A AD (TAAD), cardiac tamponade is the leading cause of death.

We describe an octogenarian with painless TAAD and cardiac tamponade. The pathophysiology contributing to the findings on CT and histology will be discussed.

Case presentation

An 80-year-old woman complained of abdominal colic, which worsened 2 days before admission. She had no chest pain and was haemodynamically stable during admission.

Initial investigations including an abdominal …