Introduction: Aortic dissection is a rare but life-threatening condition with a high mortality rate if diagnosis is delayed. Aortic dissection classically presents with sudden-onset, sharp pain in the chest or back. However, atypical presentations can also occur, which could lead to a delay in diagnosis.
\nCase Report: A patient initially presented to the emergency department (ED) with left testicular pain ongoing for several hours. On examination, he had tenderness in the left lower quadrant abdomen and left testicle. A testicular ultrasound revealed decreased blood flow to the left testicle, raising concern for testicular torsion. The patient was taken to the operating room, where no torsion was found, and he was subsequently discharged home. Several days later, the patient returned to the ED with worsening pain radiating to the back. A computed tomography revealed an acute type A aortic dissection extending to the iliac arteries. He was transferred for surgical repair and discharged 12 days later.
\nConclusion: While acute aortic dissection (AAD) typically presents with chest or back pain, atypical presentations can occur. When initial findings do not fully explain a patient’s symptoms, AAD should remain on the differential. This case highlights an uncommon presentation of AAD initially mimicking a testicular torsion.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Aortic Dissection"},{"word":"Testicular torsion"},{"word":"case report"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/12q6f8hs","frozenauthors":[{"first_name":"Bruce","middle_name":"M","last_name":"Lo","name_suffix":"","institution":"Sentara Norfolk General Hospital/Eastern Virginia Medical School at Old Dominion University, Department of Emergency Medicine, Norfolk, Virginia","department":""},{"first_name":"Megyn","middle_name":"K","last_name":"Christensen","name_suffix":"","institution":"Eastern Virginia Medical School at Old Dominion University, Department of Emergency Medicine, Norfolk, Virginia","department":""},{"first_name":"Coral","middle_name":"E","last_name":"Byrns","name_suffix":"","institution":"Eastern Virginia Medical School at Old Dominion University, Department of Emergency Medicine, Norfolk, Virginia","department":""},{"first_name":"Benjamin","middle_name":"","last_name":"Chidester","name_suffix":"","institution":"Sentara Norfolk General Hospital/Eastern Virginia Medical School at Old Dominion University, Department of Emergency Medicine, Norfolk, Virginia","department":""}],"date_submitted":"2025-07-23T04:01:14.369000Z","date_accepted":"2025-09-16T00:20:17.372000Z","date_published":"2026-01-06T07:31:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/49096/galley/48087/download/"}]}