Clinical Communications: Adults| Volume 63, ISSUE 1, e10-e16, July 2022

Aortic Dissection Presenting as Shortness of Breath from Diffuse Alveolar Hemorrhage



      Aortic dissection is a rare but well-known life-threatening disease that classically presents with tearing chest pain radiating to the back yet can have deceiving clinical presentations.

      Case Report

      A 54-year-old man with a history of hypertension presented to the emergency department with mild shortness of breath without chest pain. Point-of-care ultrasound (POCUS) detected diffuse B-lines, a dilated aortic root, aortic regurgitation, and pericardial effusion. A computed tomography angiogram confirmed a Stanford type A aortic dissection with diffuse alveolar hemorrhage (DAH), a rare complication of type A aortic dissection involving the posterior aortic wall with extension into the main pulmonary artery.

      Why Should an Emergency Physician Be Aware of This?

      Acute aortic dissection can present with a wide range of clinical manifestations with a high mortality rate for patients with an untimely diagnosis. Although an intimal flap within the aortic lumen is the characteristic finding on ultrasound, additional POCUS findings of a pericardial effusion, aortic regurgitation, and a dilated aortic root may be seen with proximal dissections. Diffuse B-lines on thoracic POCUS, although commonly associated with pulmonary edema in decompensated heart failure, can be seen in patients with DAH which has a multitude of etiologies, including aortic dissection.



      BiPAP (Bilevel Positive Noninvasive Ventilation), CTA (Computed Tomography Angiogram), DAH (Diffuse Alveolar Hemorrhage), ED (Emergency Department), IRAD (International Registry of Acute Aortic Dissection), NTG (Nitroglycerin), POCUS (Point-of-care Ultrasound)
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