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Introduction <p>Aortic dissection is a lethal vascular emergency that may present atypically as isolated limb ischemia. A specific diagnostic pitfall, termed “symptom laterality concordance,” arises when these ischemic symptoms align with a preexisting, ipsilateral lumbar spinal pathology, creating a high risk of misdiagnosis.</p> Case Report <p>We present a 64-year-old male with known right L4/5 lumbar disk herniation, initially diagnosed with radicular exacerbation due to right lower limb pain and sensory loss. The examination revealed right L5 radicular signs alongside a cool limb with a weakly palpable pulse. Vascular ultrasound showed right common iliac artery occlusion. Subsequent tearing chest pain led to a CTA diagnosis of Stanford type B aortic dissection. Despite emergent stenting, the patient succumbed to aortic rupture.</p> Conclusion <p>This case highlights “symptom laterality concordance” as a critical cognitive trap, where a vascular catastrophe mimics an ipsilateral spinal condition. It underscores the need for clinicians to carefully consider vascular pathologies in all unilateral limb presentations. We advocate for a dual vascular–neurological assessment and propose a clinical algorithm to mitigate this risk.</p>

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Symptom Laterality Concordance: Aortic Dissection Masquerading as Ipsilateral Lumbar Radiculopathy

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年3月6日

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  • Dingyuan Jiang,
  • Jinglan You,
  • Zhimin Hu,
  • Xu Zhang,
  • Qing Zhou,
  • Lin Cheng

摘要

Introduction

Aortic dissection is a lethal vascular emergency that may present atypically as isolated limb ischemia. A specific diagnostic pitfall, termed “symptom laterality concordance,” arises when these ischemic symptoms align with a preexisting, ipsilateral lumbar spinal pathology, creating a high risk of misdiagnosis.

Case Report

We present a 64-year-old male with known right L4/5 lumbar disk herniation, initially diagnosed with radicular exacerbation due to right lower limb pain and sensory loss. The examination revealed right L5 radicular signs alongside a cool limb with a weakly palpable pulse. Vascular ultrasound showed right common iliac artery occlusion. Subsequent tearing chest pain led to a CTA diagnosis of Stanford type B aortic dissection. Despite emergent stenting, the patient succumbed to aortic rupture.

Conclusion

This case highlights “symptom laterality concordance” as a critical cognitive trap, where a vascular catastrophe mimics an ipsilateral spinal condition. It underscores the need for clinicians to carefully consider vascular pathologies in all unilateral limb presentations. We advocate for a dual vascular–neurological assessment and propose a clinical algorithm to mitigate this risk.