Classical but not clinically oriented presentation

Although a catastrophic case in all terms, Abitbol and D’Urzo fail to use problem-based learning to propose useful pearls in their article on fatal aortic dissection.¹ In a condition where index of suspicion is key, aside from listing risk factors, the authors do not emphasize the importance of historical questions to identify high-risk populations including those with connective tissue disease, aortic valve disease, Turner syndrome, and family history of aneurysm or sudden cardiac death. Nor do they identify the nature of the pain: onset, quality, evolution, and signs of attendant limb ischemia and neurologic deficits are all critical to help differentiate this condition, yet none of these were detailed in their case description. The American Heart Association 2010 guidelines on thoracic aortic disease² guide the reader toward an approach that balances minimizing misdiagnosis with avoiding overinvestigation of every case of pneumonia, including reviewing the role of d-dimer testing. Perhaps this case also highlights the benefit of Canadian Family Physician providing comprehensive, up-to-date reviews on all such important diseases.

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