Aortic dissection associated with blunt chest trauma diagnosed by elevated D-dimer

• Blunt aortic injuries that are survived in the field are still associated with an extremely high mortality if the diagnosis is missed or delayed in the emergency department.
• Aortic dissection secondary to blunt trauma is not well described in the literature. Data drawn from traumatic aortic injuries suggest that signs, symptoms, and vital signs are insensitive markers for dissection.
• Further study is required before D-dimer can be recommended as a tool for diagnosing aortic injury in the setting of chest trauma, but it could prove helpful in making this sometimes-difficult diagnosis in otherwise low-risk patients.

IntroductionSimilar to spontaneous aortic dissection, traumatic aortic dissection is diagnosed with a careful history and physical exam, chest radiograph, and ultimately, dedicated aortic imaging. The diagnosis of spontaneous aortic dissection may be aided by using the serum D-dimer test. The use of D-dimer for diagnosing aortic injury in the setting of blunt trauma has not previously been reported.Presentation of caseWe present a case of aortic dissection in a 61-year-old male diagnosed when the patient presented with chest pain after blunt chest trauma.DiscussionThe patient had no known history or risk factors for aortic disease. None of the classic findings were present by history, physical examination or chest radiograph and the diagnosis was made as the result of an elevated D-dimer. We discuss how the D-dimer test fortuitously led to the diagnosis in this case, and the implications.ConclusionD-dimer could be helpful in diagnosing aortic injuries in low-risk chest trauma patients.