Bedside diagnosis of extensive aortic dissection
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CASE REPORT
Bedside diagnosis of extensive aortic dissection Sandeep Duggal Æ Matt Lyon Æ Michael Blaivas
Published online: 26 September 2009 Ó Springer-Verlag 2009
Abstract Acute aortic dissection (AAD) is a disease of relatively low incidence but very high mortality. Its presenting symptoms and signs are highly variable and frequently overlap with other less critical etiologies. The majority of patients expire prior to presentation to the Emergency Department. However, an even further complication is that nearly one-third of patients with AAD are misdiagnosed on initial evaluation. Standard imaging modalities for diagnosis of dissection include transesophageal echocardiography, CM and magnetic resonance imaging. All of these are expensive, time consuming and may not be readily available in a point of care setting. We present a case of an extensive AAD identified in a young patient with abdominal pain and neurological deficits. Point of care ultrasound allowed the identification of an intimal flap in multiple locations and resulted in rapid diagnosis and treatment. Keywords Emergency ultrasound Aortic dissection Aortic aneurysm Ultrasound
Introduction The incidence of aortic dissection ranges from 5 to 30 cases per million people per year, with the majority of patients dying before presentation to a hospital [1]. Additionally,
the clinical presentation of aortic dissection can be confusing as it may mimic myocardial infarction, stroke or other life-threatening conditions. Consequently, several studies have shown that the diagnosis of aortic dissection has been missed in up to 38% of patients on initial evaluation [2–4]. Because any delay in diagnosis can lead to a higher morbidity and mortality, it is critical to keep a high clinical index of suspicion in establishing the diagnosis of aortic dissection. Physical examination for either confirming or ruling out aortic dissection is unreliable. Radiologic imaging, however, is highly sensitive and specific with computerized tomography (CT), magnetic resonance imaging (MRI), trans-esophageal echocardiography (TEE), and angiography being the most sensitive [1]. In contrast, transthoracic echocardiography (TTE) has a sensitivity and specificity ranging from 35 to 80 and 39–96%, respectively, depending on the anatomic location of the dissection [5–8]. Yet, as more clinicians begin to use sonography at bedside, the characteristic signs of dissection, floating intimal membranes, the enlargement of the aortic root or arch, and an increase in the aortic wall thickness are occasionally encountered while the clinician is evaluating for other conditions [1]. We report of a case of aortic dissection diagnosed by expeditiously using bedside ultrasound.
Case report S. Duggal M. Lyon Section of Emergency Ultrasound, Department of Emergency Medicine, Medical College of Georgia, Augusta, GA, USA M. Blaivas (&) Northside Hospital Forsyth, Cumming, GA 30040, USA e-mail: [email protected]
A 47-year-old male presented to the emergency department approximately 45 min after smok
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