Discussion: AoD is a rare but possibly catastrophic diagnosis which typically presents with clinical features including abrupt onset of chest or back pain described as “tearing” in character, variation in pulse or blood pressure between the two arms, and mediastinal widening on chest radiograph. Hemodynamic instability is commonly reported. Because of the high mortality associated with AoD, rapid diagnosis is essential. The lack of high-risk clinical features may decrease clinical suspicion for AoD, therefore increasing likelihood of delayed or missed diagnosis. A murmur of aortic insufficiency is present in 45% of AoD cases and should warrant further aortic imaging to prevent delayed or missed diagnosis. Conclusion: This case of asymptomatic AoD highlights the clinical importance of adequate vascular examination to help identify the disease rapidly to prevent delay or missed diagnosis.
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