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Ascending Thoracic Aortic Dissection: A Case Report of Rapid Detection Via Emergency Echocardiography with
Brandon Backlund1, Anastasia Kendrick-Adey1, Rachel Harper1
1University of Washington, Department of Emergency Medicine, Seattle, WA.
Insights
Aortic dissection diagnosis can be improved with emergency focused transthoracic echocardiography (ETTE). Adding the suprasternal notch view (SSNV) to ETTE enhances visualization of the aortic arch, aiding in faster diagnosis of this critical condition.
Area of Science:
- Emergency Medicine
- Cardiovascular Imaging
- Point-of-Care Ultrasound
Background:
- Aortic dissection is a critical, time-sensitive emergency.
- Conventional imaging like CT is often unsuitable for unstable patients in the emergency department (ED).
- Standard emergency focused transthoracic echocardiography (ETTE) has limitations in visualizing the proximal aorta.
Purpose of the Study:
- To highlight the utility of the suprasternal notch view (SSNV) in diagnosing aortic dissection.
- To demonstrate how SSNV can improve diagnostic accuracy and speed in the ED setting.
- To present a case report illustrating the successful application of SSNV in managing aortic dissection.
Main Methods:
- A case report of a patient with suspected aortic dissection presenting with hypotension.
- Performance of a standard ETTE followed by an additional SSNV.
- Comparison of diagnostic findings between standard ETTE and SSNV.
Main Results:
- Standard ETTE was within normal limits.
- The additional SSNV revealed a dissection flap in the aortic arch.
- The patient underwent successful surgical repair shortly after diagnosis.
Conclusions:
- The suprasternal notch view (SSNV) is a valuable addition to emergency focused transthoracic echocardiography (ETTE).
- Incorporating SSNV can significantly improve the diagnostic accuracy and timeliness for proximal aortic dissection.
- This technique offers a crucial bedside tool for unstable patients in the emergency department.
Abstract:
Aortic dissection is a life-threatening, time-sensitive emergency. Conventional diagnostic imaging modalities such as computed tomography (CT) can be time-consuming to obtain, and require that the patient leave the emergency department (ED); as such, they are unsuitable for unstable patients. Emergency focused transthoracic echocardiography (ETTE) is commonly performed in the ED as part of the evaluation of a patient presenting with chest pain, but the suprasternal notch view (SSNV) is much less well-known and infrequently included in this assessment. We present a case of a 51-year-old previously healthy man who presented to the ED complaining of chest pain that had resolved prior to arrival, and a mild headache. His vital signs were notable for hypotension, but physical exam was unremarkable. Chest x-ray revealed a borderline widened mediastinum. A standard ETTE was within normal limits, but additional SSNV demonstrated a dissection flap in the aortic arch. The patient was taken to the operating room for surgical repair 75 minutes after the ED ultrasound was performed; the operation was successful, and the patient was discharged to home post-operatively with good outcome. Standard ETTE has limited ability to visualize the ascending aorta and aortic arch. Addition of SSNV allows visualization of these structures and may improve diagnostic accuracy and time to diagnosis of proximal aortic dissection.
Topics:
Aortic dissection, emergency echocardiography, point-of-care ultrasound, POCUS, emergency ultrasound, suprasternal notch view.
