Mottled skin of the abdominal wall

Case introduction

A 49-year-old man with hypertension under medical control presented to the ED with sudden chest pain, diaphoresis and dyspnoea. On arrival, low blood pressure were noted. His abdomen is showed in figure 1. ECG showed no ST elevation.

Questions

What is the most likely diagnosis?

Pulmonary embolism.

Myocardial infarction.

Aortic dissection type A.

Myocarditis.

Answer: 3 (aortic dissection type A)

CT angiography of the chest revealed type A aortic dissection complicated with hemopericardium and near total occlusion of the descending thoracic aorta (figure 2). Mottled skin can be a sign of poor perfusion related to undifferentiated shock, cold environment, vascular diseases (atherosclerosis, aortic aneurysm or dissection), autoimmune diseases, antiphospholipid syndrome, medications and pancreatitis.1 2 This is different from Grey-Turner sign, which is bruising of the flanks, or Cullen's sign, periumbilical bruising, which can...

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