Aortic dissection is defined as separation of layers within the intimal wall.Often presents as chest pain,shortness of breath,vomiting and acute haemodynamic compromise.We present a case of aortic dissectionwhich wasdetected by using a bedside Ultrasound (US)
A 65 years old men underlying hypertension and ischaemic heart disease. Referred from health clinic for acute myocardial infarction. Presented with left shoulder pain since one week, abdominal pain which resolved by itself and fever for one day. Denies chest pain, shortness of breath or vomiting. Patient was alert and conscious. Per abdomen revealed a pulsatile mass at the epigastric area. Other findings were normal. Electrocardiogram at emergency department showed ST elevation lead II, III, AvF, V2-V5.No ST elevation seen on posterior electrocardiogram. Chest x-ray was done which showed widened mediastinum and left pleural cap. Bedside echocardiography & abdominal US was performed and showed a dilated thoracic and abdominal aorta with an intimal flap. CT angiography was done and findings suggestive of Stanford type B thoracoabdominal aortic dissection. Presence of dissection within the proximal part renal artery and both common iliac artery.Patient’s was maintained on labetalol intravenous infusion.
Discussion and Conclusion
Aortic dissection is a life threatening condition. Using ultrasound to differentiate a true myocardial infarction or if it is secondary to aortic dissection is important. Thus, in a experienced hand, bedside ultrasound may be beneficial in detecting a dissecting aortic aneurysm.
Aortic dissection, ultrasound