Aortic dissection presenting as isolated lower extremity ischemia - A case report

Aortic dissection usually presents with severe chest pain. Widening of the mediastinum is usually evident on chest films. We report a 40-year-old man who presented with left lower extremity weakness and paresthesia. After detailed examination including arteriography, left iliac arterial occlusion was revealed. Emergency thrombectomy was done, with return of leg circulation after surgery. Shortly thereafter, a similar manifestation occurred in the right leg. Aortic dissection was found on subsequent examination. The patient's condition deteriorated, without response to treatment, and he succumbed 2 days later. Atypical presentations of aortic dissection usually occur in elderly or disabled patients. Nonetheless, isolated limb arterial occlusions in a young patient without classical symptoms and signs has been reported. Delayed diagnosis and treatment usually result in an ominous prognosis. Aortic dissection should be included in the differential diagnosis of patients with arterial occlusive diseases without chest pain.