PURPOSE: Aortic dissection (AoD) is one of the most common catastrophes 
involving the aorta. Nevertheless, early diagnosis remains to be a challenge in 
the Emergency Department (ED), particularly in young individuals. In this study, 
we attempted to identify the characteristics of acute AoD among young 
individuals, particular in patients with Marfan syndrome.
MATERIALS AND METHODS: This was an retrospective chart-review study conducted in 
a tertiary referring hospital. The hospital database was queried for the 
combination of AoD and patients under age of 40 years. The medical charts were 
reviewed to obtain demographic data, clinical data and laboratory 
characteristics by using a standardized data collection sheet. A comparison 
between Marfan syndrome and non-Marfan syndrome patients was performed.
RESULTS: During the 10-years period, 18 of 344 patients with acute AoD were 
younger than 40 years-old. Patients with Marfan syndrome developed acute AoD at 
a younger age than patients without Marfan syndrome. The mean diastolic blood 
pressure was significantly lower in patients with Marfan syndrome upon 
presenting to the ED than those without. Patients with Marfan syndrome had 
trends toward higher risk of development of type A AoD, increased recurrence 
rate and higher mortality rate than those without. However, statistical 
significance was not present.
CONCLUSION: ED physicians should have high alert to acute AoD in young patients 
presenting with severe unexplained chest and back pain, particularly in those 
patients with a history of heart diseases, hypertension, and Marfan syndrome or 
featuring Marfanoid habitus. Acute coronary syndrome, unexplained abdominal 
symptoms, and sudden cardiac arrest could be the initial manifestation of AoD in 
young patients. A low threshold to perform enhanced computed tomography may 
facilitate early diagnosis and timely treatment in this patient population.