Yanling Su^1,, Oleg Yurevich², Hal Chadow³, Shahrokh E Rafii³, Sunil Abrol⁴

A 70 years old male with past medical history of hypertension, remote history of colonic and prostate cancer and ischemic stroke came to the hospital with generalized weakness, fatigue, increased shortness of breath and decreased exercise tolerance for the past week. Bedside echocardiogram revealed large amount of pericardial effusion with signs of pericardial tamponade. Patient successfully underwent echocardiography-guided pericardiocentesis with improvement of symptoms and remained stable and 900 cc of bloody fluid was drained. Blood tests revealed markedly elevated D-dimer, elevated liver enzymes and acute kidney injury. Chest X-ray showed widened mediastinum. CT chest without a contrast indicative of ascending aortic dissection, was confirmed by magnetic resonance imaging (MRI) of the chest. During and prior to admission to our hospital patient had reported no chest pain. Cardiac tamponade was the only clinical finding, which is very unusual for acute aortic dissection to be diagnosed. Patient was transferred to another institution for surgical intervention, which revealed sealed ruptured aortic dissection into pericardium, with successful repair of the dissection, and later was discharged in stable condition.

painless, type A aortic dissection, cardiac tamponade, atypical presentation, sealed rupture