Thoracic aortic dissection mimicking primary hematological disorder: A case report

Abstract

Chronic disseminated intravascular coagulation (DIC) is uncommon and less clinically pronounced. Its diagnosis and therapymay be further delayed due to the subtle abnormal laboratory results. This may potentially contribute to an unfavorablepatient outcome. We describe a 60-year-old lady with chronic DIC who presented with progressive and recurrent unprovokedsubcutaneous hematoma for 6 months prior to presentation. On presentation, she was anemic and thrombocytopenic with amildly deranged coagulation profile. She was suspected to have hematological malignancies therefore a bone marrow aspirate andtrephine biopsy was done but revealed no abnormality. Serial DIC panel revealed persistent low fibrinogen and elevated d-dimerwhich were consistent with chronic DIC. When she was referred to our centre, baseline chest radiograph showed mediastinalwidening and subsequent computed tomography (CT) imaging confirmed the presence of Standford A dissection of thoracicaortic aneurysm. The gradual occult blood loss from the dissection lead to the consumptive coagulopathy and triggered the DICcascade. Essentially, chronic DIC never occur alone and unprovoked, therefore the main principle of management is to recognizeand address the underlying etiology in particularly aneurysms and malignancies.