Acute Aortic

Acute aortic dissection, an emergent vascular catastrophe, varies in its clinical presentation and embraces a high mortality rate if not recognized early. Here we report a 32-year-old man who presented to our emergency department (ED) because of lower-back pain shortly before orgasm, and was subsequently found to have retrograde acute type B aortic dissection. This young man was diagnosed and treated promptly in the ED and had no sequelae. We highlight that ED physicians should always include vascular emergencies (i.e. acute aortic dissection) in their differential diagnoses whilst engaging a patient with an acute-onset severe lower-back pain featuring a characteristic upward propagation that emerges following strenuous exercise (i.e. sexual intercourse) in our case. This would appear to be especially so for patients featuring elevated blood pressure regardless of patient's age or history of hypertension. ( J Intern Med Taiwan 2008; 19: 418-421)