PP150 TRANSESOPHAGEAL ECHOCARDIOGRAPHY(TEE) AS A BEDSIDE TOOL OF WONDER IN DETECTING THORACIC AORTIC DISSECTION

Abstract

Introduction:

Traumatic aortic dissection(AD) is a challenging life threatening condition to diagnose, which can be complicated by the presence of atypical presentations and clinical signs mimicking other clinical diagnoses.

Case report:

16 years-old Indian gentleman presented with lower limb weakness after an alleged motor vehicle accident. Clinically, patient sustained loss of sensation and motor function from T11 and below, with absence of bulbo-cavernosus reflex. His hemodynamics were stable with no obvious deformity. Focused Assessment Sonographic in Trauma(FAST) was negative. Magnetic Resonance Imaging finding was extradural intraspinal hematoma at L1-L2 vertebrae. Initial diagnosis of spinal shock was made. Serial FAST scan showed left haemothorax which was treated with chest tube insertion and drained out 200 millimeters of blood. Patient’s condition deteriorated despite resuscitation and he was intubated for airway protection. Point of care ultrasound(POCUS) was performed at bedside. Transthoracic echocardiography(TTE) showed dilated ascending aorta with a presence of flap. Proceeded with TEE to look for extension of dissection which revealed flap and thrombus at the ascending, arch and descending aorta. Diagnosis was revised to thoracic AD Stanford A with neurological deficit. Surgical team was referred but patient succumbed to trauma due to the extensiveness of injury.

Discussion & Conclusion

Detecting a traumatic AD requires high level of suspicion, either based on the mechanism of trauma or the imaging studies as the signs and symptoms are non-specific It is further complicated with the presence of other injuries, such as neurological deficits which are commonly manifested in polytrauma patients. The utilization of TEE in trauma is beneficial in eliciting the problem and the extension of injury especially when patient is unstable to be sent to radiological suite. Competencies in performing bedside TEE by emergency physicians are important in cases with suspected AD.