Background: Acute aortic dissection is a life-threatening disease, and its diagnosis can be challenging for first aid physicians, especially when it presents atypically. Because clinical presentations of this disease in the Chinese population are not widely reported, we performed a study to better understand the clinical manifestations of acute
aortic dissection, based on the experience of National Cheng Kung University Hospital (NCKUH). We also evaluated the impacts of atypical presentations on diagnosis and outcome.Methods: This descriptive study was conducted on a retrospective cohort of NCKUH, from 1996 to 2005. Atypical presentations, defined as those free from typical painful sensation, included syncope without preceding pain,neurological deficits, shortness of breath, nonspecific abdominal or chest discomfort, and other common atypical symptoms.Results: Atotal of 163 patients were enrolled. Classic presentations, such as migratory phenomenon, were observed
in 55% of type A patients and 66% of type B patients. Widened mediastinum in chest radiography, and pulse differential among limbs were observed in 52% and 29% of subjects, respectively. Atypical presentations were
observed in 22% of the patients. Females were more likely to present atypically than males. Atypical presentation did not have any impact on in-hospital mortality, but it was significantly related to delay in diagnosis.Conclusion: Clinicalmanifestations of aortic dissection are diverse in the Chinese population. Classic presentations should not always be expected at the emergency room. Atypical presentation is not uncommon, and may cause a delay in diagnosis. Aheightened level of attention, and correct usage of diagnostic tools such as echocardiogram and computed tomography, are needed for better diagnosis and managements of aortic dissection.