Rapidly Progressive Painless Acute Aortic Dissection: A Case Report

Acute aortic dissection (AAD) typically presents with sudden, severe chest or back pain. This case highlights an atypical painless presentation that was rapidly progressive and lethal. A 55-year-old woman presented with generalized weakness, agitation, and shortness of breath, but without pain. Initial point-of-care ultrasound (POCUS) was reassuring, but persistent agitation and emerging abdominal tenderness prompted reexamination and repeat POCUS, which revealed evidence of aortic dissection. Computed tomography angiogram (CTA) confirmed the diagnosis of a Stanford Type A dissection. Despite aggressive resuscitative efforts, the patient’s condition deteriorated rapidly. This case emphasizes the importance of observant reassessment and repeating POCUS in atypical presentations of AAD because subtle clinical changes can reveal life-threatening conditions such as aortic dissection.