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Aortic Dissection Presenting as Shortness of Breath from Diffuse Alveolar Hemorrhage

      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)
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