Fatal aortic dissection in a 37-year-old man: missed opportunity.

Acute aortic dissection (AoD) affects approximately 2000 people per year in the United States.1 The International Registry of Aortic Dissection (IRAD),2 the largest multinational registry of patients with AoD, reports that only 7% of patients with AoD are younger than 40 years of age, a factor that might not prompt a raised index of suspicion among clinicians caring for younger individuals presenting with chest symptoms compatible with AoD. Early and accurate diagnosis is crucial as the mortality rate of AoD might increase by approximately 1% per hour over the first 48 hours and can reach 70% at 1 week if left untreated.3 Because the average age of patients with AoD is 65 years,2 younger patients with AoD are especially likely to be misdiagnosed. This is illustrated in the following case in which a 37-year-old man with an AoD was thought to be experiencing community-acquired pneumonia. This case serves as a reminder to family physicians of the importance of developing broad differential diagnoses that should always include life-threatening emergencies.