An atypical case of anterograde type A dissection masked as Giant Cell Arteritis: Case Report

Abstract

Abstract Background Acute aortic dissections are medical emergencies that necessitate prompt diagnosis. Stanford Type A aortic dissections – classically presenting with tearing chest pain – can have atypical symptoms that are only recognized upon imaging. Case Presentation : We present a 70-year-old female presenting to the emergency department after outpatient visits with concern for temporal arteritis. She has a significant rheumatologic history of systemic lupus erythematosus, osteoporosis, fibromyalgia, and bilateral anserine bursitis. Given her symptoms of jaw claudication, otalgia, and elevated inflammatory markers, a diagnosis of giant cell arteritis was pursued and managed with prednisone. She endorsed worsening shortness of breath in the past week, prompting evaluation for new onset congestive heart failure. A CT was obtained and a Type A dissection extending into the bilateral carotid arteries was incidentally found. She was immediately taken to the operating room for ascending and hemiarch aortic replacement. She recovered well and did not have any complications. Conclusions Given the growing awareness of a relationship between GCA and aortic involvement, vigilance in this population can identify complications early. Clinicians should consider further examination of long standing rheumatological patients with atypical presentations given the possibility of an undiagnosed aortic dissection.