Photoclinic Diagnosis: Spontaneous Dissection of the Infrarenal Abdominal Aorta

A54-year-old woman was admitted to the hospital because of sudden onset severe abdominal pain and fatigue. Her pain was sustained and started from her left lower quadrant with radiation to the epigastric area. The pain was neither positional nor related to feeding, defication, nor activity. Severe nausea and vomiting were followed a few minutes after the onset of pain. The patient had no history of diabetes, hypertension, abdominal trauma, or intravascular intervention. She had a history of hysterectomy and oophorectomy 13 years before. Her vital signs were normal. Physical examination of the abdomen was not remarkable. Femoral, popliteal, and pedal pulses were normal on both sides. Routine laboratory investigations were normal. The pain partially relieved by the administration (CT) scan of intravenous morphine. A computerized tomography of the abdomen with oral and intravenous contrast was obtained.