Early Diagnosis of an Atypical Type A Aortic Dissection With Point-of-Care Ultrasound: A Case Report

Abstract

Aortic dissection is a rare but potentially fatal condition, characterized by a high mortality rate where every minute of delay in treatment counts. Its diagnosis remains challenging due to its often atypical clinical presentation. This case report presents an atypical case of type A aortic dissection in a 75-year-old female patient, highlighting the importance of early diagnosis facilitated by point-of-care ultrasound and emphasizing the value of its use in suspected aortic dissection regardless of the clinical probability. Additionally, this report reviews the risk factors for misdiagnosis and underscores the utility of diagnostic scores such as the aortic dissection detection risk score.

Keywords: aortic dissection; aortic dissection detection risk score (add-rs); emergency medicine; pocus; point-of-care ultrasound; type a aortic dissection.

Figure 1. ECG showing sinus rhythm with left anterior hemiblock and QRS fragmentation in lead III and no tachycardia and no ST abnormalities

ECG: electrocardiogram

Figure 2. PoCUS showing a dilated aortic root in the parasternal long-axis view (A) and a mobile flap (white arrow) in the abdominal aorta in the transverse view (B, C)

PoCUS: point-of-care ultrasound

Figure 3. CT angiogram with the axial (A) and coronal (B, C) views showing a Stanford type A thoracoabdominal aortic dissection originating from the focal ulceration of the aortic root, with a spontaneously mural hyperdense hematoma extending 6 cm in an anteroposterior direction. The intimal flap (yellow arrow) extends from the thoracoabdominal aorta to the iliac bifurcation and right external iliac artery

CT: computed tomography