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Author Spotlight: Using Point-of-Care Ultrasound for Comprehensive Evaluation of the Abdominal Aorta
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Author Spotlight: Using Point-of-Care Ultrasound for Comprehensive Evaluation of the Abdominal Aorta

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Acute aortic dissection with highly compressed true lumen: unanticipated pitfall of point-of-care ultrasonography

Hisashi Dote1, Masaaki Koide2, Shunsuke Kobayashi3

  • 1Department of Emergency and Critical Care Medicine, Seirei Hamamatsu Hospital, Hamamatsu, Japan hisashi.dote@gmail.com.

BMJ Case Reports
|March 3, 2021
PubMed

Insights

Point-of-care ultrasonography may miss acute aortic dissection (AAD) when the true lumen is compressed. Computed tomographic angiography is crucial for diagnosing Stanford type A AAD, even with negative POCUS findings.

Area of Science:

  • Cardiology
  • Radiology
  • Emergency Medicine

Background:

  • ST-segment elevation myocardial infarction (STEMI) can present with cardiogenic shock.
  • Point-of-care ultrasonography (POCUS) is increasingly used for rapid bedside assessment.
  • Acute aortic dissection (AAD) is a life-threatening condition requiring prompt diagnosis.

Observation:

  • A patient with STEMI and cardiogenic shock initially had a negative POCUS for AAD.
  • Emergency coronary angiography revealed aortic dissection.
  • Computed tomographic angiography (CTA) confirmed Stanford type A AAD with a compressed true lumen.

Findings:

  • The compressed true lumen in Stanford type A AAD can be mistaken for a normal aorta on POCUS.
  • POCUS findings for AAD can be misleading in specific anatomical presentations.
  • CTA is essential for definitive diagnosis of complex aortic dissections.

Implications:

  • Over-reliance on POCUS may delay diagnosis of critical conditions like AAD.
  • Clinicians should maintain a low threshold for CTA when suspecting AAD, regardless of POCUS results.
  • Integrating advanced imaging like CTA is vital for accurate diagnosis and management of cardiovascular emergencies.

Keywords:
pericardial diseaseprimary care

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