{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:40:06Z","timestamp":1756366806072,"version":"3.44.0"},"reference-count":6,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,12,1]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:p>Acute aortic dissection can be fatal if overlooked, and the absence of D-dimer elevation can be used to exclude acute aortic dissection. However, we report a case of acute aortic dissection without D-dimer elevation. A man in his 70s presented to the emergency department with lumbar back pain. D-dimer was &lt;1.0\u2009\u00b5g\/mL; however, acute aortic dissection was strongly suspected because of the sudden onset of lumbar back pain with a shifting location. Because of a difference in systolic blood pressure in both upper extremities, we performed a thorough examination using contrast-enhanced CT, leading to a diagnosis of acute aortic dissection. The patient was immediately referred to cardiovascular surgery and treated conservatively with antihypertensive management. The aortic dissection detection risk score (ADD-RS) classified the patient as high risk. This suggests the importance of using the D-dimer with the ADD-RS rather than solely relying on the D-dimer results to diagnose acute aortic dissection.<\/jats:p>","DOI":"10.1136\/bcr-2022-250680","type":"journal-article","created":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T10:30:11Z","timestamp":1670841011000},"page":"e250680","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Aortic dissection diagnosed with the aortic dissection detection risk score of 2 without D-dimer elevation"],"prefix":"10.1136","volume":"15","author":[{"given":"Kanako","family":"Saito","sequence":"first","affiliation":[{"name":"General Medicine, Sannohe Central Hospital, Sannohe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4399-2890","authenticated-orcid":false,"given":"Shunsuke","family":"Soma","sequence":"additional","affiliation":[{"name":"Emergency and Critical Care Center in Department of General Medicine, Aomori Prefecutural Central Hospital, Aomori, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,12,12]]},"reference":[{"key":"2025082800004886000_15.12.e250680.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13019-021-01726-1","article-title":"The diagnostic value of D-dimer in acute aortic dissection: a meta-analysis","volume":"16","author":"Yao","year":"2021","journal-title":"J Cardiothorac Surg"},{"key":"2025082800004886000_15.12.e250680.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.988568"},{"key":"2025082800004886000_15.12.e250680.3","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1111\/acem.13969","article-title":"Systematic review of aortic dissection detection risk score plus D-dimer for diagnostic rule-out of suspected acute aortic syndromes","volume":"27","author":"Bima","year":"2020","journal-title":"Acad Emerg Med"},{"key":"2025082800004886000_15.12.e250680.4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.7.897"},{"key":"2025082800004886000_15.12.e250680.5","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.ijcard.2018.01.104","article-title":"Impact of a negative D-dimer result on the initial assessment of acute aortic dissection","volume":"258","author":"Nitta","year":"2018","journal-title":"Int J Cardiol"},{"key":"2025082800004886000_15.12.e250680.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2014.04.257"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-250680","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:01:04Z","timestamp":1756364464000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-250680"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12]]},"references-count":6,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12,12]]},"published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1136\/bcr-2022-250680"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-250680","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2022,12]]}}}