Aortic dissection following “ecstasy” use complicated by compartment syndrome

Background Patients who present to the emergency department (ED) with acute chest pain should receive a thorough history and exam to rule out rare, life-threatening conditions, such as drug-induced acute aortic dissections (AD). Case presentation A 34-year-old man with a history of uncontrolled hypertension, smoking, and “ecstasy” use presented to the ED with an acute type A aortic dissection (AD). Following surgery to repair the dissection, he developed compartment syndrome of the lower extremity requiring muscle excision and neurolysis with subsequent wound debridement procedures. Conclusion Physicians treating adults with symptoms and signs of aortic dissection should take a focused history about substance use and include AD on their differential. In addition, the extremities should be monitored for signs and symptoms of ischemia throughout the acute peri-surgical period(s).