Author: Aetizaz Alam, Syed Bilal Hamdani, Syed Abbas Tayyab / Editor: Stephen Sheridan / Codes: / Published: 25/06/2026
A 77-year-old man with a past medical history of mild hypertension and type 2 diabetes mellitus presents to the Emergency Department (ED) following an episode of dull central chest pain lasting 510 minutes, followed by a presyncope episode. He reports no radiation of pain, dyspnea, diaphoresis or vomiting.
On arrival, he appears pale and acutely unwell. His vital signs reveal hypotension with a blood pressure of 85/50 mmHg, tachycardia at 110 beats per minute, temperature of 36.2 C and respiratory rate of 18 breaths per minute.
Primary assessment demonstrates a patent airway and normal breathing. However, he has fluctuated Glasgow Coma Scale (GCS) scores. Cardiovascular examination reveals muffled heart sounds and weak peripheral pulses. Notably, the left femoral pulse is absent, with radio femoral delay present. Neurological examinations are otherwise unremarkable.
Given his hemodynamic instability, an urgent EFAST scan is performed, demonstrating gross hemopericardium. The aorta scan reveals an abdominal aorta AP diameter of 3.5 cm.
In view of the concerning findings, an urgent CT full aortogram is performed. Imaging reveals intimal flap originating in the ascending aorta extending distally to the left common iliac artery, with associated hemopericardium.
The patient is immediately referred to the cardiothoracic and vascular surgeons’ team for emergency operative management.
