Insonation was introduce as a fifth pillar of physical examination which can diagnose pathology through imaging and lead us to the lethal mimicker of aorta dissection with cardiac tamponade.
A 55 years old gentleman with underlying hypertension, presented with sudden onset of left lower limb weakness. On arrival in emergency room, patient was alert with vital sign within normal range. Examination of left lower limb revealed acute ischaemic limb with non palpable pulses of the femoral, popliteal, and distal pulses. Point-of-care ultrasound showed intimal flap at abdominal aorta(Figure 1,2) and cardiac tamponade (Figure3,4). Pericardiocentesis was done under ultrasound guided.CT Angiography showed extensive long segment aortic dissection from root of ascending aorta until left common iliac artery (Standford A classification). Patient eventually succumbed to disease.
The diagnosis of aortic dissection requires high index of suspicion as it can present in many ways such stroke, myocardial infarction and acute ischaemic limb. Additional of insonation will lead us to the actual diagnosis and pericardial effusion which is the most common complication in patients with Standford type A aortic dissection. Bedside ultrasound can give us direct and indirect signs of aortic dissection which shortens the time to diagnosis.
Point of care ultrasound is a helpful rule-in tool for aortic dissection especially in those patients that come with atyipical presentations.
wave aortic dissection, insonation, cardiac tamponade with ultrasound