Abstract
Background
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.
Keywords
Abbreviations:
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 12, 2022
Accepted:
May 9,
2022
Received in revised form:
April 21,
2022
Received:
January 17,
2022
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
