A literature review did not reveal any known correlation between the patient’s history of giant-cell hepatitis or antirejection therapy with thoracic aortic dissection. Furthermore, liver transplant is not known to be a specific risk factor for AAD in pediatric patients or outside the immediate postoperative period. Therefore, there were no known predisposing risk factors for AAD in our patient.
The most common clinical feature of AAD is chest pain, which occurs in 75% of patients.1 Other clinical symptoms include hypertension and diaphoresis.2,4 However, classic clinical findings are not always displayed, making the diagnosis difficult.2,4 The classical description of “tearing pain” is seen in only 51% of patients, and 5% to 15% of patients present without any pain.1
Commonly missed or misdiagnosed. The diagnosis of AAD has been missed during the initial exam in 38% of patients.4 As seen in our case, symptoms may be initially diagnosed as musculoskeletal chest pain. Based on symptoms, AAD can be incorrectly diagnosed as an acute myocardial infarction or vascular embolization.2,4
Every hour after symptom onset, the mortality rate of untreated AAD increases 1% to 2%,with no difference based on age.3,4 Different reports have shown mortality rates between 7% and 30%.4
Effective imaging is crucial to the diagnosis and treatment of AAD, given the occurrence of atypical presentation, missed diagnosis, and high mortality rate.4 A chest radiograph will show a widened mediastinum, but the preferred diagnostic tests are a CT or transthoracic echocardiogram.2,4 Once the diagnosis of AAD is confirmed, an aortic angiogram is the preferred test to determine the extent of the dissection prior to surgical treatment.2
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