Pleuritic chest pain and fever: An unusual presentation of aortic dissection

• Published in: Malaysian family physician Vol. 14; no. 1; pp. 47 - 52
• Main Authors: Mohamed-Yassin, MS, Baharudin, N, Ramli, AS, Hashim, H
• Format: Journal Article
• Language: English
• Published: Kuala Lumpur Academy of Family Physicians of Malaysia 2019; Academy of Family Physician of Malaysia
• Subjects: Analgesics; Antibiotics; Aortic dissection; Blood pressure; Blood tests; Case Report; Coronary vessels; Curricula; Medical imaging; Nonsteroidal anti-inflammatory drugs; Pain; Patients; Pneumonia; Primary care; Proteins
• ISSN: 1985-2274; 1985-207X; 1985-2274

The CT thorax showed a dilated ascending aorta with possible dissection. [...]a CT aortogram was subsequently performed. A review of the literature shows that fever is a common accompanying feature for AD7-10 and that it has been found in one-third of all patients with AD.11 The characteristic fever in AD is distinct from that with an infective aetiology.12 It has been reported that the fever, which is secondary to AD, is seen mostly in type B dissections and that it begins between 48 to 72 hours after the dissection occurs.12 The variability in body temperature is significantly less when compared with a fever that is secondary to an infection.12 This retrospective study also showed that in patients with a fever that is secondary to AD, microbiological investigations produced negative results.12 Patients also showed no response to antibiotic therapy, and their fever subsided in 24 hours when treated with indomethacin.12 In our patient, the blood culture was negative, and his fever resolved with ibuprofen. [...]referral for CT angiography would have been the next recommended course of action and would have shown the dissection. Elevated D-dimer (>500 ng/mL) has also been found to be highly sensitive (96.7% sensitivity, 95% CI= 93.6-98.6%) for AD18 but is inadequate as a stand-alone test.19 The European Society of Cardiology recommends utilizing the Aortic Dissection Detection Risk Score (ADD-RS) and performing the D-dimer test as a secondary filter when the ADD-RS score is < 1.3 The ADD-RS is a pretest probability assessment tool that can help with AD risk stratification.4 It incorporates the presence of high risk conditions, pain, and examination features.4 The score represents the total number of groups out of three (see Figure 4 for group details) with the presence of any single risk factor.