Differentials

Aortic dissection not associated with Marfan syndrome

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

No eye or musculoskeletal findings.

Relevant family history in familial dissections.

INVESTIGATIONS

At present 51 known genes are accepted as causative for thoracic aortic aneurysm and dissection (TAAD), with new ones discovered yearly.[25]

Mutation screening for TAAD genes include TGFBR1/TGFBR2, ACTA2, MYH11, SMAD3, and TGFB2.[25][26][27][28][29][30][31]

Bicuspid aortic valve

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

No eye or musculoskeletal findings, although occasionally occurs with Marfan syndrome.

INVESTIGATIONS

Echo, thorax CT, or thorax MRI will show abnormal bicuspid aortic valve.

Ehlers-Danlos syndrome

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Joint hypermobility more common presentation.

Vascular variety, which most commonly affects the aorta, is characterised by thin skin and bleeding disorders with increased bruising.

INVESTIGATIONS

Skin biopsy for abnormal collagen and DNA testing for gene mutation.[32]

Erdheim's deformity

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Flask-like root dilation of the aortic root as in Marfan syndrome, but no eye or musculoskeletal findings or family history.

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No differentiating tests.

Homocystinuria

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Signs and symptoms very similar.

Generalised osteoporosis and disorders of mental development more likely in homocystinuria.

INVESTIGATIONS

Plasma homocysteine levels are elevated.

Loeys-Dietz syndrome

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

No associated lens dislocation.

Aortic dissection occurs at much smaller diameter.[33]

Bifid uvula or cleft palate.

Arterial tortuosity.

Hypertelorism.

INVESTIGATIONS

Mutation screening for TGFBR1, TGFBR2, SMAD3, TGFB2, and TGFB3 genes.[3][34]​​​

XXY (Klinefelter) syndrome

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

No associated lens dislocation or aortic aneurysm.

Mental deficiency.

Hypogonadism.

INVESTIGATIONS

Karyotype reveals extra X chromosome.

Marfanoid hypermobility syndrome

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

X-linked.

No eye or heart involvement.

INVESTIGATIONS

No gene identified.

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