Aortic Dissection

Abstract

Aortic dissection is a potentially catastrophic disease with significant mortality and morbidity. Presentations are often atypical and the physician needs to have a high index of suspicion and low threshold to work up these cases. Ultrasound use in the emergency department is becoming an important tool for physicians and can expedite care in many ways. The authors describe the case of a 55-year-old man with uncontrolled hypertension, who presented to the emergency department with acute chest pain radiating to the back and abdomen. A bedside cardiac ultrasound done by the emergency medicine resident showed a flap in the descending thoracic aorta with a preserved ejection fraction and no evidence of a pericardial effusion. Appropriate management was started with intravenous esmolol and nitroprusside and based on the seriousness of the ultrasound findings, a computed tomography scan was done immediately, which revealed a Stanford type B dissection extending from the aortic arch down to the left common and external iliac arteries with a likely area of infarction in the left kidney. The patient was admitted to the cardiovascular intensive care unit and a stent was placed in his left renal artery. He was subsequently discharged home in a stable condition with adequate blood pressure control. The case presentation is followed by a discussion on the diagnosis and management of acute aortic dissection, and the importance of point-of-care ultrasonography in the emergency department is also highlighted.