Aortic dissection albeit negative d-dimers and zero clinical probability – Another facet of medicine's deadly chameleon

Abstract Aortic dissection, the rupture of the aorta's intimal and medial layers, leading to the formation of a false lumen, is a relatively common disease with high mortality. So far, while not addressing penetrating aortic ulcer or intramural hematoma, current guidelines take a negative value for d-dimers for a sufficient method to rule out aortic dissection in patients with a low clinical probability, as calculated by the ADD risk score. We present two cases of patients with acute aortic dissection, albeit presenting with a low clinical probability for acute aortic dissection and negative values for d-dimers. Learning objective: One must entertain a high level of suspicion for acute aortic syndrome as even laboratory results within the normal range of d-dimers connected with a low clinical probability can be misleading. According to the patient's symptoms, a battery of different diagnostic tools should play in concert, including imaging studies, repeat clinical evaluation, and repeat laboratory tests, such as d-dimers, before dismissing a diagnosis as severe as aortic dissection.>