Expedited evaluation of atypical aortic dissection with point of care ultrasound: A case report

Background

Aortic dissection (AD) is a vascular emergency with substantial morbidity and mortality. Aortic dissections have been classically categorized into two subtypes: Stanford Type A aortic dissections involve the ascending aorta and/or aortic arch and require emergent surgical intervention. Stanford Type B aortic dissections involve the aortic arch distal to the left subclavian artery and descending aorta and can be managed medically. Despite its dire consequences, Type A dissections remain challenging to diagnose due to highly variable clinical presentations. While imaging modalities such as magnetic resonance imaging (MRI), computed tomography angiography (CTA), and transesophageal echocardiography (TEE) have high diagnostic sensitivity, they are time-intensive and may delay treatment initiation.

Case report

This case report describes the rapid diagnosis and management of a 47-year-old male patient presenting with atypical symptoms of aortic dissection, including vague chest tightness and progressive global encephalopathy. Bedside point-of-care ultrasound (POCUS) played a pivotal role in initiating timely diagnosis, intervention, and improving the clinical outcome of this patient with a Stanford Type A aortic dissection.

Why should an emergency physician be aware of this?

POCUS can provide valuable early diagnostic insights and expedite further evaluation of Stanford Type A aortic dissection. Especially in cases of atypical presentation, POCUS is a rapid and inexpensive diagnostic tool for this highly emergent and morbid condition, accelerating further definitive imaging and treatment.