Acute aortic dissection mimicking cholecystitis

BACKGROUND: Acute aortic dissection is a life-threatening medical emergency that carries a high rate of morbidity and mortality. Because presenting clinical features are diverse and serious complications occur rapidly, diagnosis is difficult to make and often missed. METHODS: We present a 48-year-old patient with a 4 h history of severe epigastric pain. Upon admission to the local hospital gastritis and cholecystitis were diagnosed. RESULTS: After laparoscopic cholecystectomy – of a histopathologically chronically inflamed gallbladder without lithiasis – the patient became hemodynamically instable, a type-A aortic dissection and pericardial tamponade were detected on CT. She was urgently transferred to our hospital and underwent an ascending aorta and hemiarch replacement in deep hypothermia and circulatory arrest. CONCLUSIONS: In up to 50% of patients with aortic dissection diagnosis is missed or delayed, since classical findings are often absent. The possibility of aortic dissection should be considered in patients suffering from intense abdominal pain diagnosed as cholecystitis.