Asymptomatic large aortic dissection from ascending to abdominal aorta in a young man with Marfan syndrome: A case report challenging conventional diagnostic paradigms

Introduction: Aortic dissection, a serious medical condition characterized by a tear in the aorta's inner layer leading to the establishment of a false channel within the vessel wall, in this report, we present a very rare case of asymptomatic substantial aortic dissection spanning from the ascending aorta to the abdominal aorta.

Case presentation: A 36-year-old male with fever and cough was found to have clinical features suggestive of Marfan syndrome. Examination revealed bilateral fine crackles and a diastolic heart murmur. Imaging showed bilateral infiltrates, hyperinflation, and aortic dissection. Echocardiography confirmed severe aortic valve regurgitation and Stanford type A dissection. Despite recommended surgery, the patient opted for medical therapy due to financial constraints, showing stable cardiac anomalies after 6 months.

Discussion: Aortic dissection, a critical cardiovascular emergency, affects mainly the elderly, exacerbated by hypertension, atherosclerosis, and connective tissue disorders. Early detection via CT and biomarkers is crucial. Type A dissections typically require surgical repair, while endovascular repair is used for complex Type B cases, reducing long-term mortality. The TEM system aids in categorization, guiding treatment. Conditions like Marfan syndrome significantly contribute to aortic wall degeneration, requiring close monitoring and intervention.

Conclusion: The coalescence of aortic dissections with Marfan syndrome underscores the need for tailored monitoring in high-risk populations and highlights the silent complexities of cardiovascular pathologies, urging refined diagnostics and therapeutic approaches.