Aortic dissection and elevated D-dimers—an important clinical link

A 73-year-old woman with previous coronary artery bypass grafting presented with acute pleuritic type chest pain, decreased oxygen saturations and markedly elevated D-dimers. Acute pulmonary embolism was suspected and because of hypotension an emergency transthoracic echocardiogram was performed to assess pulmonary hypertension. This revealed an acute type A aortic dissection. This case highlights the importance of transthoracic echocardiography as a simple noninvasive tool in the evaluation of chest pain. It also highlights more importantly the relationship of acute aortic dissection and elevated D-dimers which is of tremendous significance to the practising clinician when it comes to patient care and safety.